Job description
Utilization Review Registered Nurse (RN) to join our healthcare team in Arcata, CA. The ideal candidate will have strong clinical judgment and expertise in evaluating medical necessity, appropriateness of care, and ensuring compliance with established guidelines and payer requirements.
Job Title: Utilization Review RN
Location: Arcata, CA
Assignment Length: 13 Weeks
Shift: 8 Hours, Days
Pay Range: $52 – $55 per hour
Responsibilities:
- Conduct utilization reviews to ensure appropriate patient care levels.
- Collaborate with physicians, case managers, and insurance providers regarding patient treatment plans.
- Review patient records to assess the necessity and efficiency of healthcare services.
- Document findings accurately and maintain compliance with hospital and payer standards.
- Support discharge planning and transitions of care.
- Ensure adherence to regulatory requirements and organizational policies.
Qualifications:
- Current and valid RN license (State of CA).
- Minimum of 3 years of clinical nursing experience; prior utilization review or case management experience preferred.
- Strong knowledge of InterQual or MCG guidelines.
- Proficiency in EMR systems (EPIC/Cerner preferred).
- Excellent communication, critical thinking, and organizational skills.
- Current BLS & ACLS certification (AHA).
Job Types: Contract, Temporary
Pay: $52.00 - $55.00 per hour
Expected hours: 40 per week
Benefits:
- Referral program
Experience:
- Utilization review: 3 years (Required)
License/Certification:
- RN License (Required)
- BLS Certification (Required)
Work Location: On the road
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