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 a thrilling travel healthcare assignment in Torrance, California? TLC Nursing has an exciting opportunity for you! In this 8-week assignment, you'll immerse yourself in the vibrant healthcare landscape of Torrance, California, known for its innovative medical facilities and diverse communities. As a travel nurse specializing in Utilization Review, you'll play a crucial role in evaluating the efficiency and quality of healthcare services provided to patients. Your expertise will ensure that resources are utilized effectively, patient care is optimized, and healthcare outcomes are maximized. Join us at TLC Nursing, where our nurse-founded organization offers unparalleled support and resources to enhance your travel nursing experience. Benefit from 24/7 recruiter assistance, personalized career guidance tailored to your aspirations, and comprehensive aid with housing and licensing logistics. **Key Responsibilities:** - Conduct thorough reviews of medical records to assess the appropriateness and necessity of healthcare services. - Collaborate with healthcare providers to ensure compliance with regulatory standards and best practices. - Analyze data to identify trends, patterns, and opportunities for improvement in healthcare delivery. - Communicate findings and recommendations to stakeholders to enhance patient outcomes and resource allocation. **Weekly Pay: $1854.0** As a valued member of our team, you'll enjoy a range of exceptional 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 Are you ready to elevate your career as a travel nurse in Utilization Review? Seize this opportunity to make a meaningful impact in healthcare while exploring the beauty of Torrance, California. Apply now and embark on a rewarding journey with TLC Nursing!

Apply now