RN - Utilization Review

A healthcare organization is seeking a Registered Nurse with utilization review experience to support non-acute clinical review activities. This contract opportunity is based in the Queens, NY area and requires an active New York State RN license . The ideal candidate will have experience reviewing healthcare services for medical necessity, appropriateness, and utilization.


Responsibilities:

• Perform utilization review activities in a non-acute healthcare setting.
• Review clinical documentation and healthcare services for medical necessity and appropriateness.
• Apply established utilization management criteria, policies, and clinical guidelines when conducting reviews.
• Collaborate with clinical and administrative teams regarding utilization review findings and recommendations.
• Maintain accurate and timely documentation of review activities.
• Support compliance with organizational, regulatory, and payer requirements.
• Communicate professionally with interdisciplinary healthcare team members regarding cases under review.

Qualifications:

• Active New York State Registered Nurse license required.
• Primary Source Verification required.
• Current AHA BLS certification required.
• Minimum 1 year of non-acute utilization review experience required.
• RN experience preferred.
• Strong clinical assessment and documentation review skills.
• Ability to work effectively in a utilization management environment.
• Strong written and verbal communication skills.
• Schedule: 8:30 AM to 5:00 PM.

Please note that the salary range and/or hourly rate range of $55.00 - $65.00 per hour is a good faith determination of potential base compensation offered to applicants at the time of this job advertisement and may be subject to modification in the future. When determining a team member's base salary and/or hourly rate, various factors may be taken into account as applicable (such as location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget, and internal equity).


For consideration to this and/or other roles suitable for your background, please submit your most up-to-date resume to join our talent pool.


At ATRIA Consulting, LLC, we are a woman-owned business fully committed to promoting, cultivating, and maintaining a culture of diversity, equity, and inclusion. We embrace and celebrate differences across all demographics and backgrounds. We encourage everyone to apply.