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 seasoned Registered Nurse (RN) with a knack for Utilization Review seeking an exciting opportunity in sunny Torrance, California? TLC Nursing is thrilled to offer a captivating 8-week travel healthcare assignment that promises not only professional growth but also a chance to explore the vibrant West Coast culture. In this role, you'll dive headfirst into the dynamic world of Utilization Review, where your expertise will be instrumental in evaluating the efficiency and necessity of healthcare services provided to patients. Your sharp analytical skills and keen attention to detail will be put to the test as you collaborate with interdisciplinary teams to ensure optimal patient care and cost-effectiveness. Picture yourself strolling along Torrance Beach after a fulfilling day at work, knowing that your dedication as a travel nurse in this bustling city is making a real difference in the lives of patients. As you immerse yourself in the local community, you'll witness firsthand the diversity and energy that define California living. At TLC Nursing, we take pride in our TLC Culture, where our nurse-founded organization offers unwavering support to our healthcare professionals. From round-the-clock recruiter assistance to personalized career guidance, we are committed to your success every step of the way. Additionally, we provide assistance with housing and licensing to ensure your focus remains on delivering exceptional patient care. And the perks? How does a competitive weekly pay of $1854.0 sound to you? But wait, there's more! Enjoy an array of benefits including the best in the industry pay packages, a $25,000 Life Insurance Policy effective from day one, and comprehensive health coverage starting the 1st of the month after hire. Plus, accrue Paid Time Off from day one, become eligible for our 401(k) plan after a year, and take advantage of Aflac offerings. Don't forget about our Referral Program and Employee Assistance Program (EAP) for added support. Ready to embark on this rewarding travel healthcare assignment in Torrance, California? Take the next step in your career journey by applying now and let TLC Nursing be your trusted partner in achieving your professional goals.

Apply now