Registered Nurse (RN) - Utilization Review

Utilization Review Nurse – Nursing

Schedule: Monday - Friday from 8am - 5pm. Callback on weekends/holidays

Assignment Details:

• Contract Length: 13 weeks
• Guaranteed Hours: Normal

Requirements:

• Bachelor's Degree in Nursing
• A valid, current, full and unrestricted Professional Nursing License to practice as a Registered Nurse (RN) in any state of the United States, the Commonwealth of Puerto Rico, or a territory of the United States
• Current Basic Life Support (BLS) certification by the American Heart Association (AHA)
• Three (3) years of clinical nursing experience performing direct patient care, with at least 2 years in an inpatient setting on a medical-surgical unit, PACU, or higher acuity inpatient unit (ICU, Step-Down, Telemetry, etc.) or home health (direct care)
• Knowledge of case management, purchased referred care, and utilization review processes
• Knowledge of electronic health record systems

Roles & Responsibilities:

• Ensure patients receive appropriate care by verifying medical necessity and confirming the correct patient status.
• Monitor ongoing need for services to reduce unnecessary length of stay and prevent delays.
• Support accurate clinical documentation for proper reimbursement and coordinate with providers on discharge planning.
• Manage resource use to control costs and communicate with payers to prevent denials.
• Ensure compliance with CMS and Joint Commission requirements while contributing to quality improvement efforts.
• Serve as a liaison between clinical care, finance, and regulatory requirements to align patient care with quality standards.

Compliance / Notes:

• Orientation: Every 2 weeks
• COVID & Flu exemptions: May accept after declination form is submitted
• Housing application: Must be submitted 2 weeks prior to start

Client Details:

City: Tuba City

State: AZ

Job Board Disclaimer: TLC Nursing Associates, Inc. is an equal-opportunity employer and fully complies with all applicable federal, state, and local laws. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, disability, age, genetic information, veteran status, or any other status protected under the law. Accuracy of Information: All job listings are subject to change, and while we strive to ensure that all job information, including job descriptions, pay packages, and shift details, is accurate and up-to-date, we cannot guarantee the availability or specifics of any position at the time of application. Pay packages and shift availability may vary based on facility needs and may be subject to changes before or after hire.