RN UM

RN UM

Tryfacta is seeking an RN UM for our client in Franklin, NH 03235. This is a 9-week contract assignment. If you meet the qualifications listed below and are interested, please apply now!

Position Title: RN UM

Location: Franklin, NH 03235

Duration: 9 weeks (possible extension)

Work Schedule: Night 5x8-hour (22:00 - 06:30)

Responsibilities for this position include, but are not limited to:

• Coordinate and perform utilization management (UM) activities, including admission, continued stay, and discharge reviews in accordance with facility policies and payer guidelines.
• Assess medical records to determine the medical necessity and appropriateness of patient care and level of service.
• Collaborate with physicians, case managers, social workers, and interdisciplinary team members to facilitate efficient patient care and discharge planning.
• Communicate with insurance companies and third-party payers to obtain prior authorizations and concurrent review approvals.
• Monitor patient progress, identify barriers to discharge, and assist in developing appropriate care transition plans.
• Maintain accurate, timely documentation of utilization review activities and payer communications in the electronic medical record.
• Ensure compliance with CMS, Medicare, Medicaid, Joint Commission, and facility-specific utilization management standards.
• Participate in quality improvement initiatives, audits, and departmental meetings as assigned.

To be considered for this position, you should have:

• Active Registered Nurse (RN) license in the applicable state required.
• Minimum 2 years of recent Utilization Management (UM), Utilization Review (UR), Case Management, or Care Coordination experience required.
• Previous experience in an acute care hospital or inpatient setting preferred.
• Strong knowledge of InterQual, MCG (Milliman), Medicare, Medicaid, commercial insurance guidelines, and medical necessity criteria preferred.
• Experience with electronic medical record (EMR) systems such as Epic, Cerner, Meditech, Allscripts, or similar preferred.
• Excellent clinical assessment, critical thinking, documentation, and communication skills.
• Ability to collaborate effectively with physicians, payers, and interdisciplinary healthcare teams.
• Must be able to work MondayFriday, Day Shift (8:00 AM 4:30 PM) with a 40-hour guaranteed work week.
• Current BLS Certification preferred (if required by facility).

Tryfacta is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.