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 sharp eye for detail and a knack for Utilization Review? Elevate your career with a captivating 8-week travel healthcare assignment in the vibrant city of Torrance, California. As a dedicated RN specializing in Utilization Review, you will play a pivotal role in assessing the efficiency and quality of healthcare services provided, ensuring optimal patient care outcomes. Your keen analytical skills will be put to the test as you collaborate with interdisciplinary teams and leverage your clinical expertise to streamline processes and maximize resource utilization. This unique opportunity in Torrance, California, offers not just a chance to expand your professional horizons but also a gateway to explore the rich culture and diverse landscapes of Southern California. From the picturesque beaches to the bustling city life, Torrance provides the perfect backdrop for your next adventure as a travel nurse. At TLC Nursing, we take pride in our nurse-founded organization that prioritizes your success. With 24/7 recruiter support, personalized career guidance, and assistance with housing and licensing, we ensure that you are fully supported every step of the way. Join a team that values your expertise and empowers you to thrive in your career. **Weekly Pay: $1854.0** **Guaranteed Hours: 40.0** **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 Ready to take the next step in your career as a travel nurse in Torrance, California? Seize this opportunity to make a difference and apply today to embark on a fulfilling journey with TLC Nursing.

Apply now