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 seasoned Registered Nurse (RN) with a knack for Utilization Review seeking an exciting travel healthcare assignment? Look no further than the captivating desert landscapes of Tuba City, Arizona! As a dedicated travel nurse specializing in Utilization Review, you will play a crucial role in assessing healthcare services to ensure efficient and effective patient care. Your keen eye for detail and strong analytical skills will be instrumental in evaluating medical records, treatment plans, and resource utilization to optimize patient outcomes. Here at TLC Nursing, we pride ourselves on our nurse-centric approach. From our 24/7 recruiter support to personalized career guidance, we are committed to supporting you every step of the way. Plus, we take the stress out of relocation by assisting with housing and licensing, so you can focus on what you do best – providing top-notch patient care. In addition to the unparalleled professional growth opportunities this assignment offers, you'll enjoy Best in the Industry Pay Packages, a $25,000 Life Insurance Policy effective from Day One, and comprehensive Medical, Dental, and Vision Insurance available the 1st of the month after hire. Take advantage of Paid Time Off, starting from Day 1 and 401(k) eligibility after 1 year of employment. Our Aflac options, Referral Program incentives, and Employee Assistance Program (EAP) are just a few more ways we invest in your well-being. Ready to embark on this rewarding journey as a travel nurse in Utilization Review in Tuba City, Arizona? Apply now and take the next step in your healthcare career with TLC Nursing!