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 8-week adventure in the vibrant healthcare landscape of Torrance, California? This is your opportunity to dive into a dynamic travel healthcare assignment that promises not only professional growth but also an unforgettable West Coast experience. In this role, you will be at the forefront of assessing healthcare service efficiency and ensuring optimal patient care delivery. Your expertise in Utilization Review will be instrumental in evaluating medical necessity, conducting utilization audits, and collaborating with interdisciplinary teams to enhance healthcare outcomes. Joining this travel nurse assignment in Torrance, California, you will immerse yourself in a bustling healthcare environment, soaking in the diverse patient population and cutting-edge medical practices that define this region. Your contributions as a Registered Nurse (RN) specializing in Utilization Review will play a pivotal role in shaping the healthcare landscape of this community. With a competitive weekly pay of $1854.0, this assignment offers not only a fulfilling professional opportunity but also a comprehensive benefits package that includes Best in the Industry Pay Packages, a $25,000 Life Insurance Policy effective from Day One, and Medical, Dental, and Vision Insurance available starting the 1st of the month after hire. Additionally, you can look forward to Paid Time Off from Day 1, eligibility for 401(k) after 1 year of employment, and access to Aflac for added financial security. At TLC Nursing, our nurse-founded culture ensures that you receive 24/7 recruiter support, personalized career guidance, and assistance with housing and licensing, making your transition to this travel healthcare assignment seamless and stress-free. If you are ready to embark on a transformative journey as a Registered Nurse (RN) specializing in Utilization Review in the bustling city of Torrance, California, then seize this opportunity today and apply to be part of our dedicated team. This is more than just a job; it's a chance to make a difference while exploring a new corner of the country. Join us in delivering quality care and shaping the future of healthcare. Apply now!

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