Travel Nurse RN - Utilization Review - $60 to $64 per hour in Portales, NM

Registered Nurse (RN) | Utilization Review
Location: Portales, NM
Agency: Conflux Systems Inc
Pay: $60 to $64 per hour
Shift Information: Days - 5 days x 8 hours
Contract Duration: 13 Weeks
Start Date: ASAP

About the Position

Job Summary

We are seeking an experienced Registered Nurse (RN) for a Utilization Review & Swing Bed Case Manager position. The RN will coordinate patient care, discharge planning, utilization review, and swing bed admissions while collaborating with physicians and the interdisciplinary care team to ensure appropriate levels of care and timely patient transitions.

Key Responsibilities

• Perform utilization review, discharge planning, and routine case management.
• Coordinate and manage the Swing Bed Program, including patient admissions and placements.
• Evaluate patients for Medicare, Medicaid, HMO, Swing Bed, and private insurance eligibility.
• Communicate with patients and families to assess discharge needs and develop care plans.
• Participate in daily multidisciplinary rounds with physicians and healthcare staff.
• Coordinate timely discharge planning and ongoing case documentation.
• Obtain referrals and prior authorizations for Home Health, DME, SNF, Acute Rehab, and specialty services.
• Complete MDS documentation as required for Swing Bed patients.
• Run InterQual reviews for all inpatient (IP) and observation (OBS) admissions.
• Educate providers and staff on utilization management, documentation requirements, and appropriate levels of care.

Requirements

Required Qualifications

• Active Registered Nurse (RN) license.
• Previous experience in Utilization Review, Case Management, or Discharge Planning in an acute care setting.
• Knowledge of Medicare, Medicaid, HMO, Swing Bed, and private insurance guidelines.
• Experience with InterQual criteria and utilization management.
• Strong communication, organizational, and interdisciplinary collaboration skills.
• Experience obtaining prior authorizations and coordinating post-acute services.

Preferred Qualifications

• Previous Swing Bed Coordinator experience.
• MDS documentation experience.
• Acute Care RN Case Management background.
• Familiarity with utilization review, appeals, and denial management.

#0119