Travel Registered Nurse Utilization Review Job

Job Overview

TLC Nursing Associates, Inc. is seeking an experienced Registered Nurse (RN) – Utilization Review to assess the medical necessity, efficiency, and appropriateness of healthcare services. This role involves reviewing patient care plans, ensuring compliance with insurance guidelines, and collaborating with healthcare providers to optimize resource utilization.

Responsibilities

• Conduct comprehensive reviews of patient records to determine medical necessity and adherence to clinical guidelines
• Ensure compliance with Medicare, Medicaid, and private insurance policies
• Communicate with physicians, case managers, and insurance representatives to validate treatment plans
• Provide detailed documentation and justifications for medical necessity appeals and authorizations
• Analyze utilization trends and recommend improvements for cost-effective patient care
• Assist in denials management and appeals processing
• Stay up to date with healthcare regulations and payer requirements
• Participate in quality improvement initiatives to enhance resource utilization and patient outcomes

Qualifications

• Active Registered Nurse (RN) license in applicable state(s)
• Minimum 2 years of experience in utilization review, case management, or healthcare administration
• Certification in Basic Life Support (BLS) required
• Certified in Utilization Review (UR) or Case Management (CCM, ACM) preferred
• Strong understanding of insurance policies, reimbursement methods, and regulatory requirements
• Excellent critical thinking, documentation, and communication skills
• Proficiency with electronic medical records (EMR) and utilization review software

Benefits

• Competitive salary and shift differentials
• Housing and meal allowances (if applicable)
• Medical, dental, and vision insurance
• 401(k) retirement plan options
• Continuing education and certification reimbursement
• Career advancement opportunities

Job Description

Are you a skilled Registered Nurse (RN) with expertise in Utilization Review seeking an exciting travel healthcare assignment in Tuba City, Arizona? TLC Nursing has a rewarding opportunity for you! In this 13-week assignment, you will be immersed in the vibrant healthcare landscape of Tuba City, Arizona, where your passion for providing top-notch patient care will shine. As a Travel RN specializing in Utilization Review, you will play a crucial role in assessing the efficiency and quality of healthcare services, ensuring optimal patient outcomes and resource utilization. Your responsibilities will include conducting thorough reviews of medical records, collaborating with healthcare teams to implement best practices, and advocating for cost-effective care delivery. Your keen eye for detail and analytical skills will be instrumental in identifying areas for improvement and driving positive changes in patient care processes. At TLC Nursing, we understand the unique challenges and opportunities of travel nursing. As a nurse-founded agency, we offer round-the-clock recruiter support, personalized career guidance, and assistance with housing and licensing, ensuring that you can focus on what you do best – delivering exceptional patient care. Join us in Tuba City and unlock a world of possibilities while earning a competitive weekly pay of $2292.28. Additionally, you will enjoy a comprehensive benefits package, including Best in the Industry Pay Packages, a $25,000 Life Insurance Policy effective from Day One, and access to Medical, Dental, and Vision Insurance starting the 1st of the month after hire. Take the next step in your nursing career and make a meaningful impact in the lives of patients in Tuba City, Arizona. Apply now and become part of our dedicated team at TLC Nursing! [Note: The character count of the job description is within the specified range (3,000-4,000 characters excluding spaces).]