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 a passion for Utilization Review looking to embark on an exciting travel healthcare assignment in Torrance, California? TLC Nursing has the perfect opportunity for you! In this 8-week assignment, you will dive into the vibrant healthcare landscape of Torrance, California, known for its cutting-edge medical facilities and diverse patient population. As a travel nurse specializing in Utilization Review, you will play a crucial role in assessing the efficiency and quality of healthcare services provided, ensuring optimal outcomes for patients while maximizing resources. Your responsibilities will include conducting comprehensive reviews of patient medical records, collaborating with healthcare teams to streamline processes, and implementing strategies to enhance the quality of care delivery. Your expertise as a Registered Nurse (RN) will be instrumental in identifying areas for improvement and facilitating effective communication among healthcare professionals. At TLC Nursing, we understand the importance of supporting our nurses every step of the way. As a nurse-founded agency, we offer 24/7 recruiter support, personalized career guidance, and assistance with housing and licensing to ensure your assignment is smooth and successful. **Weekly Pay: $1,854.0** Joining TLC Nursing comes with a multitude of benefits, including: - 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 If you are ready to elevate your nursing career, make a difference in patient care, and explore the dynamic healthcare landscape of Torrance, California, apply now to embark on this rewarding travel healthcare assignment with TLC Nursing.

Apply now