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Registered Nurse Utilization Review- Rn Case Management (IN PERSON)- Sign on Bonus

i4 Search Group

Job Description

Job Description

To Apply for this Job Click Here



Position: UTILIZATION REVIEW RN- Case Management (IN PERSON) - SIGN ON BONUS

Location: Alamogordo, NM **Onsite- In person (40 HRS)

Schedule: Days

Responsibilities:

  • Meets expectations aligned with organizational competency models, including Leader of Self, Leader of Others, or Leader of Leaders.
  • Conducts prior authorization reviews to assess whether proposed services are covered and medically necessary for the beneficiary.
  • Promotes quality, cost-effective outcomes through prior authorization and concurrent review using evidence-based clinical guidelines.
  • Identifies and escalates cases involving potential quality of care concerns, questionable admissions, or extended lengths of stay to the Medical Director.
  • Refers beneficiaries with complex or chronic conditions for care coordination, including transition of care, disease management, and behavioral health support as appropriate.
  • Adheres to all applicable HIPAA regulations to ensure the privacy and security of Protected Health Information (PHI).
  • Maintains confidentiality of sensitive data and ensures compliance with national health information standards.
  • Reviews and analyzes clinical documentation submitted by providers to determine medical necessity, appropriateness, and efficiency of services, procedures, and facility use.
  • Conducts provider outreach to coordinate post-discharge care, encourage use of in-network services, support durable medical equipment needs, and perform necessary follow-up.
  • Applies the nursing process and critical thinking skills to oversee services and evaluate care options.

Job Requirements:

  • Graduate of an accredited vocational nursing program or equivalent required
  • Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) preferred

Experience:

  • 3–5 years of nursing experience preferred
  • Proficiency with Microsoft Office applications (Outlook, Teams, Word, Excel) required
  • General computer proficiency required

Licenses/Certifications:

  • Active LVN license in the state of employment or compact license required
  • Active RN license in the state of employment or compact license preferred

#ZRAI To Apply for this Job Click Here
Vacancy posted 14 days ago
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