Registered Nurse - Utilization Review Job at ATD Technology LLC, Apple Valley, CA

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  • ATD Technology LLC
  • Apple Valley, CA

Job Description

Job Overview

Title: Registered Nurse Utilization Review (Remote)
Department: Utilization Review
Type: Travel / Contract 16 Weeks
Schedule: Day 5x8-Hour (08:00 16:30), 4 weekend shifts required per 6-week period
Start Date: 10/06/2025

Job Description Summary:

We are seeking an experienced Registered Nurse (Utilization Review) for a 16-week remote contract assignment. This role focuses on concurrent and retrospective utilization review for acute hospital patients, ensuring adherence to clinical guidelines, regulatory requirements, and payer authorization criteria.

Responsibilities:
  • Perform admission reviews, concurrent reviews, continued stay reviews, and retrospective reviews.

  • Apply InterQual Criteria and clinical judgment to assess medical necessity.

  • Conduct prior authorizations, pre-cert reviews, appeals, denials, and audits.

  • Ensure compliance with CMS, Department of Health, HIPAA, OSHA, NCQA, and Joint Commission standards .

  • Collaborate with case managers, providers, and payers to ensure appropriate utilization of services.

  • Accurately document reviews in Epic EMR and ensure timely communication with payers.

  • Participate in audits, HEDIS measure tracking, DRG validation, and regulatory reporting.

  • Cover 4 weekend shifts (day) within a 6-week period.

Key Requirements:
  • Must be a seasoned traveler (hard stop).

  • Strong acute care management experience (ICU, MS, Surgical Services exposure preferred).

  • Comfortable handling large patient review ratios (1:35 45).

  • Must be proficient with Epic charting system .

  • Must demonstrate knowledge of CPT/ICD-10 coding, DRG, CMS/Medicare guidelines, and utilization management processes .

  • Familiarity with Ca and Medi-Cal regulations preferred.

Qualifications

Education:

  • Graduate of an accredited School of Nursing (BSN preferred).

Experience:

  • Minimum 2 years of acute care management/utilization review nursing experience required.

  • Prior travel nursing experience required.

License:

  • Active Registered Nurse (RN) license in applicable state(s).

  • Compact license acceptable, depending on state coverage.

Skills:

  • Utilization Review, Admission Criteria, Appeals & Denials, Audits.

  • InterQual Criteria utilization (required).

  • Knowledge of regulatory frameworks: CMS, HIPAA, OSHA, NCQA, DRG, HEDIS.

  • Strong analytical, communication, and documentation skills.

ATD Technology, LLC is a certified minority woman owned business that creates opportunities to match qualified individuals with client programs while meeting all parties' financial and technical goals. ATD is a full service provider with offerings in Contract, Permanent and Temp-to-Perm staffing solutions. We serve Fortune 1000, mid cap and small cap companies in the Commercial, Public and Government sectors.

Job Tags

Permanent employment, Contract work, Temporary work, Remote work, Shift work,

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