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 a rewarding travel healthcare assignment? TLC Nursing has an exciting opportunity in the picturesque city of Pocatello, Idaho, waiting just for you! In this 13-week assignment, you will be immersed in the vibrant healthcare landscape of Pocatello, Idaho, known for its stunning natural surroundings and welcoming community. As a travel nurse specializing in Utilization Review, your role will involve conducting comprehensive assessments of patient care to ensure optimal utilization of healthcare services and resources. Your critical thinking skills will be put to the test as you collaborate with interdisciplinary teams to evaluate the efficiency and quality of care provided to patients. Join our nurse-founded agency that prioritizes your needs and well-being. TLC Nursing offers round-the-clock recruiter support, personalized career guidance, and assistance with housing and licensing to make your transition seamless. **Weekly Pay: $1756.0** As part of the TLC family, you'll enjoy a wide range of benefits, including: - Best in the Industry Pay Packages - $25,000 Life Insurance Policy – Effective from Day One - Medical, Dental, and Vision Insurance – available the 1st of the month after hire - Paid Time Off – Accrued Day 1, eligible after 1 year of employment (unless required earlier by state law) - 401(k) – Available after 1 year of employment; fully vested after 5 years - Aflac – Available for employee purchase - Referral Program – Payouts for referring other healthcare professionals - EAP – Free, confidential services for employees and their households via Invest EAP Don't miss out on this incredible opportunity to expand your skills, explore a new location, and make a difference in the lives of patients in Pocatello, Idaho. Apply now and take the next step in your travel nursing career with TLC Nursing!