Job Overview

TLC Nursing Associates, Inc. is seeking an experienced Registered Nurse (RN) – Utilization Review to assess the medical necessity, efficiency, and appropriateness of healthcare services. This role involves reviewing patient care plans, ensuring compliance with insurance guidelines, and collaborating with healthcare providers to optimize resource utilization.

Responsibilities

Conduct comprehensive reviews of patient records to determine medical necessity and adherence to clinical guidelines
Ensure compliance with Medicare, Medicaid, and private insurance policies
Communicate with physicians, case managers, and insurance representatives to validate treatment plans
Provide detailed documentation and justifications for medical necessity appeals and authorizations
Analyze utilization trends and recommend improvements for cost-effective patient care
Assist in denials management and appeals processing
Stay up to date with healthcare regulations and payer requirements
Participate in quality improvement initiatives to enhance resource utilization and patient outcomes

Qualifications

Active Registered Nurse (RN) license in applicable state(s)
Minimum 2 years of experience in utilization review, case management, or healthcare administration
Certification in Basic Life Support (BLS) required
Certified in Utilization Review (UR) or Case Management (CCM, ACM) preferred
Strong understanding of insurance policies, reimbursement methods, and regulatory requirements
Excellent critical thinking, documentation, and communication skills
Proficiency with electronic medical records (EMR) and utilization review software

Benefits

Competitive salary and shift differentials
Housing and meal allowances (if applicable)
Medical, dental, and vision insurance
401(k) retirement plan options
Continuing education and certification reimbursement
Career advancement opportunities

Job Description

Are you a skilled Registered Nurse (RN) with expertise in Utilization Review seeking an exciting travel healthcare assignment in Torrance, California? Look no further! This opportunity offers a dynamic 8-week placement with a competitive weekly pay of $1854.0. In this role, you will play a crucial part in assessing the efficiency and necessity of healthcare services provided to patients, ensuring that resources are allocated appropriately. Your keen eye for detail and analytical skills will be instrumental in conducting thorough reviews to optimize patient care outcomes. Join our team in Torrance, California, a vibrant city known for its beautiful beaches, diverse culinary scene, and cultural attractions. As a travel nurse, you will have the chance to explore the stunning landscapes of California while making a meaningful impact in the healthcare industry. At TLC Nursing, we pride ourselves on our nurse-founded organization that provides round-the-clock recruiter support, tailored career advice, and assistance with housing and licensing. We prioritize your needs and well-being, offering a range of benefits including Best in the Industry Pay Packages, a $25,000 Life Insurance Policy effective from day one, and comprehensive medical, dental, and vision insurance starting the 1st of the month after hire. Additionally, you'll enjoy perks like Paid Time Off from day one, eligibility for our 401(k) plan after one year of employment, and access to Aflac for supplemental coverage. Our Referral Program rewards you for bringing in other healthcare professionals, while our Employee Assistance Program (EAP) provides free and confidential services for you and your household via Invest EAP. Don't miss out on this incredible opportunity to enhance your career while experiencing the best of what California has to offer. Apply now and take the next step towards a rewarding travel healthcare assignment as a Registered Nurse (RN) specializing in Utilization Review in Torrance, California.

Apply now