RN - Case Management

Utilization Review Nurse

Location: Juneau, Alaska

Assignment Duration: This is a 13-week contract position.

Job Description: The Utilization Review Nurse is responsible for managing the progression of patient care, ensuring adherence to evidence-based protocols and expediting care delivery for patients admitted to the healthcare facility. This role involves assessing patient records, reviewing hospitalization necessity, and ensuring timely and appropriate discharges.

Responsibilities:

• Review patients' records and evaluate progress.
• Monitor hospitalization necessity and appropriateness, including length of stay and quality of care.
• Provide Utilization Management (UM) functions for patients admitted to other facilities.
• Collaborate with healthcare teams to develop personalized treatment plans.
• Ensure documentation supports UM functions and communicates with payers within required timeframes.
• Facilitate educational programs regarding regulations affecting UM.
• Respond to appeals and maintain logs for utilization review and appeals.
• Support quality improvement initiatives through comprehensive reviews.

Required Experience / Certifications / Licensure:

• Bachelor's Degree in Nursing.
• Active nursing license in Alaska.
• 8 years clinical care or nursing experience, with 3 years in chart review or related quality services.
• Case Management certification preferred (i.e., NCQA or CCMC).
• Knowledge of medical necessity, insurance reimbursement regulations, and basic coding (ICD-9 and CPT).

Why ARMStaffing?

• Health Benefits: Medical, Dental, Vision, Life, and more
• Onboarding Made Easy: We handle physicals, titers, and more so you can focus on care
• Clinical Support: In-house clinical team available to assist and advocate
• 401k Retirement Plan: Eligible after waiting period; 4% match with 5% contribution
• Recruiter Matching: Get paired with a recruiter based on your location and specialty
• Extras: Travel reimbursement, housing allowance, meals, referral bonuses, and more

We're not the only ones who think ARMStaffing should be your first choice. Here's why:

• SIA's Top-50 Fastest Growing Healthcare Staffing Firms 2019
• SIA's Largest Healthcare Staffing Agencies in the U.S. 2023
• Top Workplace in the Lehigh Valley 2022, 2023
• Perfect scores for 'Name, Not a Number' and 'Recruiters' Personalities' on Highway Hypodermics
• We've earned The Joint Commission's Gold Seal of Approval for healthcare staffing 15 years strong and counting!

Contract & local rates may vary based on location and applicant residency. Ask your ARMStaffing recruiter for details!