Open Position: RN - Utilization Review

Estimated Gross Weekly Pay: $2208.20

Opportunity:

RN - Case Management/Utilization Review (Remote)

Job Details:

* Shift hours are 8:00 AM - 4:30 PM or 9:00 AM - 5:30 PM Pacific Standard Time
* Position is 100% remote
* Laptop, keyboard, and mouse will be provided
* Must work in Pacific Standard Time
* Rotate every third weekend for the length of the contract
* Supports three facilities with rotation between all three
* Minimum 3 years of acute medical Care Manager/Utilization Management experience performing utilization review in a hospital setting (not health plan or medical group) required
* Epic proficiency required with recent use within the last 6-12 months (hard stop)
* InterQual criteria experience required (hard stop)
* Medicare knowledge required (hard stop)
* California license required
* California Medi-Cal experience and knowledge preferred
* Experience with HMOs, IPAs, etc. required
* Experience with Medicare regulations regarding specific UM processes such as CC44s, ABNs, HINNs, and MCSNs required
* Patient ratio of 40 patients
* Serves patient age groups including adolescents, adults, pediatrics, and geriatrics
* Variety of service lines and levels of care including inpatient, Extended Hospital Outpatient, and observation
* Performs concurrent review, continued stay reviews, pre-certification review, prior authorizations, and retrospective review
* Zero overtime unless approved by leadership prior to end of shift
* Zero working off the clock
* Strict adherence to all California labor laws regarding lunches and breaks
* Must commit to working 3 of the 5 holidays: Thanksgiving, Christmas Eve, Christmas Day, New Year's Eve, and New Year's Day
* May be expected to float between sister facilities nearby contracted facility

Facility:

This healthcare organization operates a centralized Utilization Management team supporting multiple facilities across a large integrated health system. The department handles a variety of service lines and levels of care, including inpatient, Extended Hospital Outpatient, and observation settings, serving a diverse patient population ranging from pediatrics to geriatrics. The team is fully remote and is committed to delivering high-quality care coordination and utilization review services across its network.

Location:

Remote, CA

Working remotely in California offers the flexibility to enjoy the state's unparalleled diversity of landscapes, culture, and lifestyle, from stunning coastlines and mountain ranges to vibrant urban centers. California's rich amenities and year-round mild climate make it an exceptional place to live and work from home.

Equal Employment Opportunity Statement:

Noor Group is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic.

Physicial Requirements:

This position requires the ability to perform the essential functions of the role, which may include standing for extended periods, bending, reaching, and lifting up to 50 pounds on an occasional basis, with or without reasonable accommodation. Physicial demands may vary depending on assignment and client-site requirements.