Registered Nurse - Utilization Review

Hanker Systems Inc.; Sacramento (CA); Remote; USD 62,000 - 70,000; Full time

Job summary

Hanker Systems Inc. is seeking a skilled Registered Nurse for Utilization Management/Utilization Review in a 100% remote role. California licensure is required, with 3+ years in acute hospital care management and recent utilization review experience.

Epic proficiency and Medicare knowledge are essential to support compliant reviews across three facilities. Responsibilities include concurrent reviews for inpatient/observation, admission decisions, and care level determinations using InterQual.

Qualifications

• California RN license required and valid.
• Minimum 3 years in acute hospital Care Management/Utilization Management.
• Recent hospital-based Utilization Review experience required.
• Epic experience required; recent use in last 6–12 months.

Responsibilities

• Perform concurrent utilization reviews for inpatient, observation, and extended outpatient levels of care.
• Review admissions and continued stays for medical necessity using InterQual criteria.
• Evaluate clinical documentation to determine appropriate level of care and continued stay.
• Collaborate with physicians, Case Management, and multidisciplinary teams regarding utilization and medical necessity.
• Review patient status and ensure compliance with Medicare and regulatory requirements.
• Support care coordination and appropriate utilization of healthcare resources.
• Manage prior authorization and pre-certification activities when applicable.
• Review clinical information involving ICU, Medical-Surgical, pediatric, and other acute-care populations.
• Maintain accurate and timely documentation within Epic.
• Support centralized UM operations across three facilities and rotate assignments based on department needs.
• Maintain productivity while managing a caseload of approximately 40 reviews/patients.

Skills

Acute care exp

UM/UR exp

InterQual criteria

Epic

Medicare knowledge

Physician collaboration

Documentation accuracy

Education

California RN license

Tools

Epic EMR

Job description

Pay:

$45.00 - $51.00 per hour

Job description:Position DetailsPosition:

RN Utilization Management / Utilization ReviewSetting:

100% RemoteSchedule:

5x8-hour daysHours:

8:00 AM 4:30 PM or 9:00 AM 5:30 PM

Pacific TimeWeekend:

Every third weekend rotationTypical Caseload:

Approximately 1:40Equipment:

Laptop, keyboard, and mouse providedRequired QualificationsActive

California RN licenseMinimum

3 years of acute hospital Care Management/Utilization Management experienceRecent hospital-based Utilization Review experience requiredEpic experience required

, with recent use within the last 6 12 monthsInterQual experience requiredStrong

Medicare knowledge requiredExperience determining medical necessity and appropriate level of careImportant: Health plan or medical group UM experience alone does not meet the requirement. Candidates need acute hospital-based Care Management/UM experience.Key ResponsibilitiesPerform concurrent utilization reviews for inpatient, observation, and extended outpatient levels of care.Review admissions and continued stays for medical necessity using

InterQual criteria

.Evaluate clinical documentation to determine appropriate level of care and continued stay.Complete admission, concurrent, continued stay, and retrospective reviews.Collaborate with physicians, Case Management, and multidisciplinary teams regarding utilization and medical necessity.Review patient status and ensure compliance with Medicare and regulatory requirements.Support care coordination and appropriate utilization of healthcare resources.Manage prior authorization and pre-certification activities when applicable.Review clinical information involving ICU, Medical-Surgical, pediatric, and other acute-care populations.Maintain accurate and timely documentation within Epic.Support centralized UM operations across three facilities and rotate assignments based on department needs.Maintain productivity while managing a caseload of approximately 40 reviews/patients.