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 knack for Utilization Review seeking an exciting opportunity in sunny Torrance, California? TLC Nursing is offering a captivating 8-week travel healthcare assignment that promises both professional growth and a chance to explore the vibrant culture of Southern California. In this role, you will dive into the heart of Utilization Review, utilizing your expertise to assess the efficiency and quality of healthcare services provided. Your keen eye for detail and analytical skills will be instrumental in ensuring that patients receive the most effective and appropriate care during their stay. As a travel nurse stationed in Torrance, you'll have the chance to immerse yourself in the dynamic healthcare landscape of California while experiencing the unique blend of urban living and coastal beauty that the region has to offer. This is not just a job—it's a chance to make a difference in a new community while expanding your professional horizons. Join us at TLC Nursing, where our nurse-founded ethos ensures that you receive unparalleled support throughout your assignment. From round-the-clock recruiter assistance to personalized career guidance, we've got you covered. Plus, we take care of the logistics so you can focus on what you do best—caring for patients. And the perks? We've got you covered there too. With best-in-the-industry pay packages, a $25,000 life insurance policy effective from day one, and comprehensive health benefits including medical, dental, and vision insurance available right from the start, your well-being is our priority. Add in paid time off, a 401(k) plan, Aflac options, a referral program, and access to free, confidential EAP services, and you've got a package that truly values your hard work and dedication. Ready to take the next step in your nursing career? Apply now and let TLC Nursing guide you on a fulfilling journey through your next travel healthcare assignment.

Apply now