Utilization Review Registered Nurse
Torrance, CA
Revolution Healthcare Services
5x8 hrs, Days
Referral Bonus

Start Date: February 23, 2026
Location: Torrance, California
Compensation: Details provided to qualified applicants
Schedule: 100% remote; caseload of approximately 40 patients; every third weekend rotation required; Pacific Standard Time hours

Highlights:

• Fully remote Care Manager/Utilization Review position supporting multiple service lines and levels of care including inpatient, Extended Hospital Outpatient, and observation
• Epic EMR system used exclusively; InterQual criteria required for all utilization review decisions
• Diverse patient population spanning pediatrics, adolescents, adults, and geriatrics with variety of acute and chronic diagnoses
• 60 hours of orientation provided; flexibility to support three facilities within the region
• Opportunity for one pre-approved time off period during assignment
• Professional development through standardized modules and ongoing compliance training

Requirements:

• Minimum 3 years of acute hospital-based Care Manager/Utilization Review experience (hospital setting required, not health plan or medical group)
• Current proficiency with Epic EMR (used within the last 6-12 months)
• Demonstrated experience utilizing InterQual criteria (required)
• Knowledge of Medicare regulations including CC44s, ABNs, HINNs, and MCSNs
• Experience with HMOs, IPAs, and managed care organizations
• Familiarity with California healthcare regulations and Medi-Cal strongly preferred
• Skills in pre-certification review, prior authorizations, concurrent and retrospective review, medical necessity determination, and care coordination
• Understanding of CPT coding, DRG, HIPAA guidelines, and Joint Commission standards
• Minimum of 2 supervisory references covering at least 1 year of comparable utilization review experience within the last 3 years

Why It's a Great Opportunity:

This fully remote Care Manager position offers the flexibility of working from home while making a meaningful impact on patient care across multiple service lines and age groups. You'll be part of a centralized utilization management team that ensures appropriate, evidence-based care for diverse patient populations while supporting efficient resource utilization. The role provides excellent exposure to various care settings and payer types, enhancing your professional expertise in utilization review and case management.