<p>Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health delivery systems in California, seeks an accomplished <strong>Utilization Review Nurse.</strong></p><p>______________________________________</p><p><br></p><p><br></p><p>NOTE- THIS IS 100% REMOTE ROLE & ONLY W2 CANDIDATES/NO C2C/1099</p><p><br></p><p><br></p><p><em>*** Candidate must be authorized to work in USA without requiring sponsorship ***</em></p><p><br></p><p><br></p><p><strong>Position: Utilization Review CA Registered Nurse (Job Id: 3513605)</strong></p><p><strong>Location: Torrance CA 90503 (100% REMOTE)</strong></p><p><strong>Duration: 3 Months + Strong Possibility of Extension</strong></p><p>___________________________________________________________</p><p><strong>Work Settings</strong></p><p><br></p><p>Acute Hospital</p><p>Ambulatory*</p><p>Case Management/Utilization Review</p><p>Admission Criteria</p><p>Benefits Eligibility*</p><p>Care coordination</p><p>Concurrent Review</p><p>Continued Stay Reviews</p><p>Determine Medical Necessity per Evidence-Based Guidelines</p><p>Disease management</p><p>Plan of Care</p><p>Pre-Cert Review*</p><p>Prior Authorizations*</p><p>Retrospective Review</p><p>Utilize InterQual Criteria</p><p>Utilization Review</p><p><br></p><p><strong>Admission Criteria</strong></p><p>Concurrent Review</p><p>Continued Stay Reviews</p><p>CPT (Current Procedural Terminology) coding and billing</p><p>Medical Necessity</p><p>Pre-Cert Review*</p><p>Prior Authorization*</p><p>Retrospective Review</p><p>Utilize InterQual Criteria</p><p>Regulatory</p><p><strong>CMS: Centers for Medicare and Medicaid Services</strong></p><p>CPT (Current Procedural Terminology) coding and billing</p><p>Department of Health</p><p>DRG (Diagnosis Related Groups)</p><p>HIPAA guidelines (Health Insurance Portability and Accountability Act)</p><p>ICD 10 Coding*</p><p>The Joint Commission/ Core Measure/National Safety Goals</p><p>Acute Hospital Experience by Specialty</p><p><br></p><p><strong>Emergency Department</strong></p><p>ICU</p><p>MS</p><p>NICU*</p><p>Pediatrics*</p><p>PICU*</p><p>SDU/PCU/IMC/Obs</p><p>Surgical Services</p><p>Women’s Services*</p><p>Additional Skills</p><p>CA and Medi-Cal experience/knowledge*</p><p>Patient Diagnoses:</p><p>variety of adult/pediatric acute and chronic diagnoses</p><p><br></p><p><strong>Position Requirements:</strong></p><p><br></p><ul><li>HARDSTOP INTERQUAL and EPIC are required</li><li>Medicare knowledge is a hardstop</li><li>at least 3 years acute UM experience</li><li>Laptop, keyboard and mouse will be provided by the facility</li><li>MUST have CA license</li><li>Must have EPIC experince</li><li>If only Kaiser experience, not enough experience, will need to redirect.</li><li>Special Procedures/Unit Details:</li><li>this dept is 100% remote, with a variety of service lines and levels of care (inpatient, Extended Hospital Outpatient and OBS).</li><li>3-year acute medical Care Manager/UM experience performing utilization review in a hospital setting (not health plan/medical group)</li><li>InterQual required, this is a Hardstop</li><li>Experience with HMOs, IPAs, etc.</li><li>Experience with Medicare 2MN rule and other regulations, regarding specific UM processes, such as CC44s, ABNs, HINNs, MCSNs, etc.</li><li>Proficient with Epic, recent use required within the last 6-12 months</li></ul><p><br></p><p><strong>Special Equipment:</strong></p><ul><li>For those candidates staffing the centralized UM team, these are also some additional things we require:</li><li>Every other weekend rotation for the length of contract.</li><li>FLEXIBILITY – our team supports four facilities and our caregivers will rotate between all four.</li><li>Must work in Pacific Standard Time.</li><li>Strict adherence to all CA labor laws regarding lunches, breaks etc. as well as -</li><li>ZERO overtime unless approved by leadership prior to end of shift.</li><li>ZERO working off the clock</li></ul><p>_____________________________________________________________</p><p><br></p><p><br></p><p><strong>Bhupesh Khurana</strong></p><p><strong>Lead Technical Recruiter</strong></p><p><strong>Email – bkhurana@ameritconsulting.com</strong></p><p><br></p><p><br></p><p><strong>Company Overview:</strong></p><p><br></p><p><strong>Amerit Consulting</strong> is an extremely fast-growing staffing and consulting firm. Amerit Consulting was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to Fortune 500 companies nationally, as well as small to mid-sized organizations on a local & regional level. Currently, Amerit has over 2,000 employees in 47 states. We develop and implement solutions that help our clients operate more efficiently, deliver greater customer satisfaction, and see a positive impact on their bottom line. We create value by bringing together the right people to achieve results. Our clients and employees say they choose to work with Amerit because of how we work with them - with service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients businesses forward.</p><p><br></p><p><em>Amerit Consulting provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.</em></p><p><em>This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.</em></p><p><em>Applicants, with criminal histories, are considered in a manner that is consistent with local, state and federal laws</em></p>