RN - Utilization Review - 26-11016

Job Description

Job Description

RN – Utilization Review

Location: East Elmhurst, NY
Employment Type: Contract – 13 Weeks 

Pay Rate

• Travel: $2,550–$2,630 per week
• Local: $69–$73 per hour

Position Summary

We are seeking a Registered Nurse (RN) – Utilization Review to evaluate healthcare services for medical necessity, appropriateness, and compliance with established clinical guidelines.

The ideal candidate will have experience in non-acute utilization review , along with strong clinical documentation and medical record review skills.

Key Responsibilities

• Perform utilization review of healthcare services and medical records.
• Assess medical necessity and appropriateness of requested services.
• Review clinical documentation against established criteria and guidelines.
• Identify gaps, discrepancies, or inconsistencies in clinical documentation.
• Collaborate with providers, care management teams, and other healthcare professionals.
• Communicate utilization review decisions and requests for additional clinical information.
• Maintain accurate and timely documentation of utilization review activities.
• Ensure compliance with organizational, regulatory, and payer requirements.

Required Qualifications

• Minimum 1 year of non-acute utilization review experience – Required
• Active New York State RN License – Required
• AHA BLS Certification – Required
• Primary Source Verification – Required

Required Skills

• Utilization Review
• Registered Nurse (RN) Experience
• Medical Necessity Review
• Clinical Documentation Review
• Care Management

BENEFITS: This position does not offer any additional benefits.