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) specializing in Utilization Review seeking a thrilling opportunity in the picturesque city of Everett, Washington? We have a captivating 13-week travel healthcare assignment awaiting you, offering a competitive weekly pay of $2275.3. In this role, you will be responsible for conducting comprehensive Utilization Review assessments to ensure the efficient and effective use of healthcare resources. Your expertise will play a crucial role in optimizing patient care outcomes, streamlining processes, and enhancing overall quality within the healthcare facility. At TLC Nursing, we pride ourselves on our nurse-founded organization, providing round-the-clock recruiter support, tailored career advice, and assistance with accommodation and licensing needs. Join us in our commitment to delivering exceptional patient care while advancing your career in a supportive and dynamic environment. If you are ready to embark on this exciting travel nurse opportunity in Everett, Washington, don't hesitate to apply and take advantage of our industry-leading benefits package, including a $25,000 Life Insurance Policy effective from day one, comprehensive medical, dental, and vision insurance, generous paid time off, 401(k) options, Aflac coverage, a rewarding referral program, and access to free, confidential EAP services for you and your loved ones. Seize this chance to elevate your nursing career and make a meaningful impact in the healthcare industry. Apply now and let your journey begin with TLC Nursing.

Apply now