Remote Registered Nurse - Utilization Management

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

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