RN - Utilization Review - Syracuse, NY - RN26-06292

Job Title: RN - Utilization Review

Location: Syracuse, NY

Type: Contract | 14 Weeks

Shift & Schedule: Day Shift | Full-Time | Monday–Friday

Position Overview:
Navitas Healthcare, LLC is seeking RN - Utilization Review for an exciting Travel or Local job in Syracuse, NY.

Responsibilities

• Conduct utilization review activities for inpatient admissions and continued stays
• Review medical records to determine medical necessity and appropriate level of care using established screening criteria
• Ensure compliance with CMS regulations, payer requirements, and hospital policies
• Collaborate with physicians, case managers, nursing staff, and payers regarding authorization and care coordination
• Interface with healthcare payers and regulatory agencies regarding patient status and reimbursement requirements
• Monitor admission status, discharge planning, and length of stay management
• Maintain accurate and timely documentation within the electronic medical record system
• Participate in quality improvement and performance initiatives related to utilization management
• Identify and escalate cases requiring physician advisor review or additional clinical documentation
• Support denial prevention and appeal processes when necessary

Requirements

• Current New York State RN License required
• Current BLS Certification required
• Minimum 1.5 years of recent acute care hospital experience within the last 2 years required
• Strong clinical assessment, critical thinking, and analytical skills
• Excellent verbal and written communication skills
• Ability to work independently and collaboratively in a fast-paced healthcare environment

Preferred Qualifications

• Utilization Review, Utilization Management, or Case Management experience preferred
• Experience with MCG or InterQual screening tools preferred
• Knowledge of CMS regulations related to hospital admissions and utilization review preferred
• Experience interfacing with healthcare payers and regulatory agencies preferred
• EPIC EMR experience preferred
• Experience with payer authorization processes and denial management preferred
• Trauma center or large hospital experience preferred

For more details contact at View email address on jobs.institutedata.com or Call / Text at View phone number on jobs.institutedata.com.

About Navitas Healthcare, LLC: 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.