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 expertise in Utilization Review seeking a thrilling travel healthcare assignment in the picturesque city of Arcata, California? Look no further! In this 13-week opportunity, you will immerse yourself in the vibrant healthcare community of Arcata, nestled among the stunning redwoods and Pacific coastline. As a travel nurse specializing in Utilization Review, you will play a pivotal role in evaluating the efficiency and quality of healthcare services, ensuring optimal patient care and resource utilization. Your responsibilities will encompass conducting comprehensive reviews of patient records, collaborating with healthcare teams to streamline processes, and recommending improvements to enhance the overall quality of care delivery. By leveraging your expertise in Utilization Review, you will contribute to maximizing healthcare outcomes and operational efficiencies in a dynamic clinical setting. Join us at TLC Nursing, where our nurse-founded organization prioritizes your success. Benefit from 24/7 recruiter support, personalized career guidance, and assistance with housing and licensing, ensuring a seamless transition into your travel healthcare assignment. **Weekly Pay: $2,193.00** **Guaranteed Hours: 40.0 hours** As part of our commitment to your well-being, we offer an array of unrivaled benefits, including Best in the Industry Pay Packages, a $25,000 Life Insurance Policy effective from Day One, and comprehensive Medical, Dental, and Vision Insurance available the 1st of the month after hire. Additionally, enjoy Paid Time Off accruing from Day 1, 401(k) eligibility after 1 year of employment, and Aflac options for supplemental coverage. Engage in our Referral Program for rewarding payouts and access free, confidential services for yourself and your household through our Employee Assistance Program (EAP). Ready to elevate your career with this exciting travel healthcare assignment? Apply now and embark on a fulfilling journey with TLC Nursing!

Apply now