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 expertise in Utilization Review seeking an exciting travel healthcare assignment in Everett, Washington? TLC Nursing has a fantastic opportunity for you! In this 13-week assignment, you will step into the vibrant healthcare landscape of Everett, Washington, where you'll be immersed in a dynamic clinical setting. As a travel nurse specializing in Utilization Review, you will play a crucial role in evaluating the efficiency and quality of healthcare services provided, ensuring optimal patient outcomes and resource utilization. Your responsibilities will include conducting comprehensive reviews of patient cases, collaborating with interdisciplinary teams to develop care plans, and optimizing healthcare delivery processes. By leveraging your expertise in Utilization Review, you will contribute to enhancing the overall quality of care provided to patients in this bustling Washington community. Join TLC Nursing, a nurse-founded agency that prioritizes your success. Benefit from best-in-the-industry pay packages, a $25,000 life insurance policy effective from day one, and comprehensive medical, dental, and vision insurance available from the 1st of the month after hire. Enjoy paid time off accrued from day one, eligibility for 401(k) after 1 year of employment, and access to Aflac for additional coverage. Take advantage of our referral program for exciting payouts and our Employee Assistance Program (EAP) for free, confidential services. At TLC Nursing, we pride ourselves on our TLC Culture. As a nurse-founded agency, we provide 24/7 recruiter support, personalized career guidance, and assistance with housing and licensing, ensuring you have the support you need to thrive in your travel healthcare assignment. Are you ready to elevate your career as a Registered Nurse (RN) specializing in Utilization Review in Everett, Washington? Apply now to embark on this rewarding journey with TLC Nursing!

Apply now