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) seeking an exciting Utilization Review assignment in sunny Torrance, California? This 8-week travel healthcare opportunity offers a competitive weekly pay of $1864.0, with guaranteed hours of 40.0 for your peace of mind. In this role, you will play a crucial part in assessing the efficiency and quality of healthcare services provided, ensuring that resources are utilized effectively to deliver optimal patient care. Your attention to detail and analytical skills will be put to the test as you review medical records, collaborate with healthcare teams, and make recommendations for improved care coordination. Join our team and experience the TLC Culture at TLC Nursing, a nurse-founded agency dedicated to supporting healthcare professionals like you. Benefit from 24/7 recruiter assistance, personalized career guidance, and assistance with housing and licensing throughout your assignment. As a valued member of our team, you will enjoy a comprehensive benefits package, including Best in the Industry Pay Packages, a $25,000 Life Insurance Policy effective from Day One, and Medical, Dental, and Vision Insurance available the 1st of the month after hire. Additionally, you'll have access to Paid Time Off accrued from Day 1, eligibility for 401(k) after 1 year of employment, and Aflac options for added coverage. Take advantage of our Referral Program for payouts when you refer other healthcare professionals and access free, confidential services for you and your household through our EAP. Ready to embark on this rewarding travel healthcare assignment in Torrance? Apply now to take the next step in your career journey.

Apply now