Hospice and Palliative Care Nurse

Job Description :

Job Title : Hospice Medical Record Reviewer / Hospice and Palliative Care Nurse

Job Location : Remote (must have reliable wired internet connection)

Job Duration : 3 Months (Potential to Extend or Convert)

Note : Must Have CA RN License

Position Summary

Seeking an experienced Registered Nurse (RN) to join the Utilization Management and Hospice Review team. The ideal candidate will have strong clinical judgment, experience reviewing hospice medical records, and the ability to make sound, timely decisions in a fast-paced environment. This role requires high attention to detail, multitasking ability, and proficiency with documentation and Excel-based auditing.

Key Responsibilities

Review and audit hospice medical records for accuracy, completeness, and compliance with Medi-Cal and Blue Shield policies.

Evaluate hospice care documentation to ensure medical necessity and adherence to regulatory and payer guidelines.

Collaborate with interdisciplinary teams including MCS, Promise, Claims, and Mandates departments to resolve discrepancies.

Apply utilization management principles to assess appropriateness of hospice and palliative services.

Maintain accurate and timely documentation of findings and recommendations.

Use Excel and other software tools to track reviews, compile reports, and support audit initiatives.

Participate in performance improvement and quality assurance activities.

Required Qualifications

Active Registered Nurse (RN) license (CA preferred or Compact).

Minimum 3+ years of hospice experience including medical record review.

Experience with Medi-Cal or other government insurance programs.

Strong knowledge of Utilization Management (UM) procedures and clinical audit processes.

Advanced proficiency with Microsoft Excel and EMR systems.

Exceptional attention to detail and ability to work independently under tight timelines.

Preferred Qualifications

Prior experience in audit, case management, or quality review.

Background in palliative care, medical-surgical, or chronic disease management.

Familiarity with Blue Shield of California systems or similar managed care environments.

Soft Skills

Excellent written and verbal communication.

Analytical thinking and decision-making under pressure.

Collaborative, self-directed, and organized work style.

Compassionate and mission-driven approach to end-of-life care.