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 an exciting travel healthcare assignment in the picturesque city of Everett, Washington? In this 13-week opportunity, you'll immerse yourself in a dynamic healthcare environment while enjoying a competitive weekly pay of $2275.3. As a travel nurse in Everett, Washington, you'll have the chance to explore the stunning Pacific Northwest landscapes and vibrant local culture during your off-duty hours. Your role as a Utilization Review RN will involve collaborating with interdisciplinary teams to assess healthcare services' efficiency and quality, ensuring optimal patient outcomes and cost-effective care delivery. Your critical thinking skills and clinical expertise will be instrumental in evaluating medical records, conducting utilization reviews, and implementing evidence-based care protocols. Joining this travel healthcare assignment not only offers a fulfilling professional experience but also a range of enticing 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 starting the 1st of the month after hire. Additionally, you'll enjoy Paid Time Off from day one, eligibility for 401(k) after 1 year of employment, and access to Aflac for supplemental coverage. At TLC Nursing, a nurse-founded agency, you'll benefit from 24/7 recruiter support, personalized career guidance, and assistance with housing and licensing needs. Our commitment to your well-being extends beyond the workplace through our Employee Assistance Program (EAP), providing free and confidential services for you and your household. Don't miss this opportunity to elevate your career as a travel nurse in Everett, Washington. Apply now to embark on a rewarding journey with TLC Nursing and make a meaningful impact in healthcare. Ready to take the next step? Apply today and let your nursing expertise shine in this exciting travel healthcare assignment.

Apply now