Registered Nurse - Utilization Review - RNSC

Job Description

Job Description

Registered Nurse (RN) – Utilization Review

Location: Syracuse, NY

Job Type: 14-Week Contract | Traveler or Local

Shift: Day Shift (Monday–Friday)

Hours: 8 Hours Per Day

Pay Rate: $60 - $65/hour

We are seeking an experienced Registered Nurse (RN) with Utilization Review and acute care experience to support medical necessity reviews, regulatory compliance, and care coordination activities. The RN will collaborate with physicians, case managers, insurance providers, and interdisciplinary teams to ensure appropriate utilization of healthcare services while promoting quality and cost-effective patient care.

• Active New York State Registered Nurse (RN) License required.

• Current BLS Certification required or ability to recertify.

• Minimum 1.5 years of recent acute care hospital experience required.

• Utilization Review, Utilization Management, or Case Management experience strongly preferred.

• Familiarity with InterQual and/or MCG criteria required or strongly preferred.

• Knowledge of CMS regulations related to hospital admissions and inpatient criteria required.

• Experience working with healthcare payers and regulatory agencies preferred.

• EPIC EMR experience preferred.

• Strong analytical, communication, and documentation skills.

• Clean professional license history with no suspensions, investigations, or malpractice claims.

• Must pass all required health, drug screening, and background check requirements.

• Conduct clinical reviews for inpatient admissions and continued stay authorization.

• Apply InterQual, MCG, and evidence-based criteria for medical necessity determinations.

• Review patient charts and clinical documentation for appropriateness of care.

• Collaborate with physicians, case managers, and interdisciplinary teams.

• Communicate with insurance companies, payers, and regulatory agencies regarding authorization decisions.

• Support discharge planning and appropriate level-of-care transitions.

• Ensure compliance with CMS regulations and hospital policies.

• Document utilization review decisions accurately and timely in EMR systems.

• New York State Registered Nurse (RN) License

• Basic Life Support (BLS)

• Experience with InterQual and/or MCG Criteria

• Prior Utilization Management or Case Management Experience

• EPIC EMR Experience

• Experience Working with Insurance Payers and Regulatory Agencies

• Acute Care Hospital Environment

• Collaborative Case Management and Utilization Review Department

• Focus on Regulatory Compliance and Efficient Patient Flow

• Strong Interdisciplinary Team Structure

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It is a Joint Commission Certified / WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.