Remote Utilization Management RN — 6-Month Contract (CA)

Amerit Consulting; California; Remote; USD 90,000 - 120,000; Part time

Job summary

Amerit Consulting seeks an experienced Registered Nurse (Utilization Management) for a 6-month contract with potential extension or conversion to a full-time role. This is a 100% remote position for California residents with standard business hours (08:00 AM - 05:00 PM PT).

The ideal candidate reviews medical documents to determine the appropriate level of care, audits hospital bills for contract compliance and medical necessity, and conducts retrospective utilization reviews using

Qualifications

• Current California RN license
• At least 5 years of relevant experience
• Concurrent or post-service inpatient review experience a plus
• Microsoft Office including Teams and Outlook
• EMR experience preferred
• Independent motivation, strong work ethic, and solid computer navigation skills
• Managed care experience including inpatient claims or concurrent review preferred

Responsibilities

• Review medical documents to determine the most appropriate level of care
• Audit hospital itemized bills for contract compliance, medical necessity, and proper billing
• Perform retrospective utilization reviews using evidence-based guidelines
• Present cases to Medical Director for oversight and determinations
• Communicate determinations to providers and members in compliance with regulations
• Identify potential quality of care issues and delays and intervene as appropriate
• Review coding logic using industry standards and CMS guidelines
• Triages and prioritizes cases to meet turnaround times

Skills

RN license

5+ years experience

EMR experience

MS Office (Teams/Outlook)

Managed care experience

Strong computer navigation

Tools

MS Teams

Outlook

Job description

Amerit Consulting seeks an experienced Registered Nurse (Utilization Management) for a 6-month contract with potential extension or conversion to a full-time role. This is a 100% remote position for California residents with standard business hours (08:00 AM - 05:00 PM PT).

The ideal candidate reviews medical documents to determine the appropriate level of care, audits hospital bills for contract compliance and medical necessity, and conducts retrospective utilization reviews using