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 dedicated Registered Nurse (RN) with expertise in Utilization Review seeking an exciting travel healthcare assignment in Torrance, California? TLC Nursing has a rewarding opportunity for you! In this 8-week assignment, you will immerse yourself in the vibrant healthcare landscape of Torrance, California, known for its blend of coastal beauty and urban sophistication. As a travel nurse specializing in Utilization Review, you will play a crucial role in optimizing patient care by evaluating treatment plans, ensuring medical necessity, and maximizing healthcare resources efficiently. At TLC Nursing, we understand the unique demands of travel healthcare assignments. As a nurse-founded agency, we provide round-the-clock recruiter support to ensure your professional needs are met. Additionally, count on personalized career guidance, assistance with housing arrangements, and support for licensing requirements—all tailored to enhance your experience in Torrance. **Responsibilities:** - Conduct comprehensive reviews of patient medical records to assess utilization of healthcare services - Collaborate with multidisciplinary teams to ensure care plans align with best practices and regulatory guidelines - Identify opportunities for improving quality of care and cost-effectiveness through data analysis and evidence-based practices - Communicate findings and recommendations to healthcare providers to enhance decision-making processes **Benefits:** - Best in the Industry Pay Packages - $25,000 Life Insurance Policy – Effective from Day One - Medical, Dental, and Vision Insurance – available the 1st of the month after hire - Paid Time Off – Accrued Day 1, eligible after 1 year of employment (unless required earlier by state law) - 401(k) – Available after 1 year of employment; fully vested after 5 years - Aflac – Available for employee purchase - Referral Program – Payouts for referring other healthcare professionals - EAP – Free, confidential services for employees and their households via Invest EAP Are you ready to elevate your nursing career through this unparalleled travel healthcare assignment in Torrance, California? Join TLC Nursing today and embark on a transformative journey where your skills are valued, and your well-being is our priority. Apply now to seize this opportunity and experience the TLC difference firsthand!

Apply now