Open Position: RN - Utilization Review

Estimated Gross Weekly Pay: $2715.00

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Opportunity:

Utilization Review / Case Management - RN

Job Details:

* In-person position Monday through Friday with the possibility of transitioning to remote
* No weekends or holidays required
* Shift start time between 8:00 AM or 9:00 AM depending on candidate availability
* Pre-approved time off not to exceed 5 days per contract
* 1 year of experience required
* Must be highly proficient in EPIC and InterQual for clinical review and medical necessity determination
* EPIC experience must be noted in work history
* Community hospital experience required
* Trauma Level I experience preferred
* Performs concurrent review, continued stay reviews, and admission criteria evaluations
* Applies CMS (Centers for Medicare and Medicaid Services) guidelines and medical necessity criteria
* Utilizes InterQual criteria for clinical decision-making
* Responsible for CPT coding, billing, and delivery of MOON notices
* Patients served are adults
* Two supervisor references required when applying
* California state license required in-hand when applying (EMSA not accepted)
* All required certifications must be in-hand when applying

Facility:

This is a large acute care hospital with 459 beds, offering a wide range of inpatient and outpatient services. The facility supports a robust utilization review and case management program, emphasizing clinical excellence and adherence to regulatory standards. The organization utilizes EPIC as its primary charting system and follows InterQual criteria for medical necessity determinations.

Location:

California

California offers an exceptional quality of life with its diverse landscapes, vibrant culture, and year-round mild climate, making it an attractive destination for healthcare professionals. From stunning coastlines and national parks to world-class dining and entertainment, California provides endless opportunities for adventure and relaxation outside of work.

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.