Registered Nurse - Utilization Review

Hanker Systems, Inc.; United States; Remote; USD 94,000 - 106,000; Full time

Job summary

Hanker Systems, Inc. is seeking an experienced RN for Utilization Management / Utilization Review. This 100% remote role follows a 5x8-hour schedule aligned to Pacific Time, with weekend rotation every third weekend, and provides a laptop, keyboard, and mouse.

Typical caseload is approximately 1:40. The ideal candidate holds an active California RN license, with at least 3 years in acute hospital Care Management/UM, and has Epic and InterQual experience to support medical necessity decisions

Qualifications

• Active California RN license.
• Minimum 3 years of acute hospital Care Management/UM experience.
• Recent hospital-based Utilization Review experience required.
• Epic experience with recent use within the last 6–12 months.
• InterQual experience required.
• Strong Medicare knowledge.
• Experience determining medical necessity and level of care.

Responsibilities

• Perform concurrent utilization reviews for inpatient, observation, and extended outpatient levels of care.
• Review admissions and stays for medical necessity using InterQual criteria.
• Evaluate 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.

Skills

Care Management

Utilization Review

Medicare knowledge

Collaboration with physicians

Education

RN license (California)

Tools

Epic experience

InterQual criteria

Job description

Job Details

• Setting: 100% Remote
• Hours: 8:00 AM 4:30 PM or 9:00 AM 5:30 PM Pacific Time
• Weekend: Every third weekend rotation
• Typical Caseload: Approximately 1:40
• Equipment: Laptop, keyboard, and mouse provided

Pay

$45.00 - $51.00 per hour

Job Description

Position Details

• Position: RN Utilization Management / Utilization Review
• Setting: 100% Remote
• Schedule: 5x8-hour days
• Hours: 8:00 AM 4:30 PM or 9:00 AM 5:30 PM Pacific Time
• Weekend: Every third weekend rotation
• Typical Caseload: Approximately 1:40
• Equipment: Laptop, keyboard, and mouse provided

Required Qualifications

• Active California RN license
• Minimum 3 years of acute hospital Care Management/Utilization Management experience
• Recent hospital-based Utilization Review experience required
• Epic experience required, with recent use within the last 6 12 months
• InterQual experience required
• Strong Medicare knowledge required
• Experience determining medical necessity and appropriate level of care

Important

Health plan or medical group UM experience alone does not meet the requirement. Candidates need acute hospital-based Care Management/UM experience.

Key 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.
• 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.