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 skilled Registered Nurse (RN) with a passion for Utilization Review seeking an exciting travel healthcare assignment in Torrance, California? TLC Nursing is offering an exceptional 8-week opportunity with a competitive weekly pay of $1854.0, providing you with a chance to immerse yourself in the vibrant healthcare landscape of sunny California. As a travel nurse specializing in Utilization Review, you will play a vital role in evaluating the efficiency and necessity of healthcare services, ensuring that patients receive high-quality care while managing costs effectively. Your expertise will be instrumental in assessing medical records, collaborating with interdisciplinary teams, and optimizing healthcare resources to enhance patient outcomes. At TLC Nursing, our nurse-founded organization is dedicated to supporting healthcare professionals like you every step of the way. With 24/7 recruiter assistance, personalized career guidance, and assistance with housing and licensing, we prioritize your success and well-being throughout your assignment. Join us in Torrance, California, where you will have the opportunity to explore the diverse culture, beautiful beaches, and endless entertainment options that this dynamic city has to offer. Your travel healthcare assignment promises not only professional growth but also a chance to experience the best of California living. If you are ready to take the next step in your nursing career and embark on this rewarding journey, apply now to seize this incredible opportunity. TLC Nursing offers the best in the Industry Pay Packages, a $25,000 Life Insurance Policy from Day One, comprehensive Medical, Dental, and Vision Insurance, Paid Time Off, a 401(k) plan, Aflac options, a Referral Program, and Employee Assistance Program (EAP) for you and your household. Don't miss out on this chance to elevate your nursing career while enjoying the perks of a travel assignment in beautiful Torrance, California. Apply today and let TLC Nursing empower you to thrive in your profession.

Apply now