Registered Nurse (RN) - Utilization Review

**Utilization Review Nurse – Nursing** **Schedule:** Monday - Friday from 8am - 5pm. Callback on weekends/holidays **Assignment Details:** Contract Length: 13 weeks Guaranteed Hours: Normal **Requirements:** - Bachelor’s Degree in Nursing - A valid, current, full and unrestricted Professional Nursing License to practice as a Registered Nurse (RN) in any state of the United States, the Commonwealth of Puerto Rico, or a territory of the United States - Current Basic Life Support (BLS) certification by the American Heart Association (AHA) - Three (3) years of clinical nursing experience performing direct patient care, with at least 2 years in an inpatient setting on a medical-surgical unit, PACU, or higher acuity inpatient unit (ICU, Step-Down, Telemetry, etc.) or home health (direct care) - Knowledge of case management, purchased referred care, and utilization review processes - Knowledge of electronic health record systems **Roles & Responsibilities:** - Ensure patients receive appropriate care by verifying medical necessity and confirming the correct patient status. - Monitor ongoing need for services to reduce unnecessary length of stay and prevent delays. - Support accurate clinical documentation for proper reimbursement and coordinate with providers on discharge planning. - Manage resource use to control costs and communicate with payers to prevent denials. - Ensure compliance with CMS and Joint Commission requirements while contributing to quality improvement efforts. - Serve as a liaison between clinical care, finance, and regulatory requirements to align patient care with quality standards. **Compliance / Notes:** - Orientation: Every 2 weeks - COVID & Flu exemptions: May accept after declination form is submitted - Housing application: Must be submitted 2 weeks prior to start