Utilization Review Registered Nurse (RN) - 26-07363

Utilization Review Registered Nurse (RN)

Duration: 13 Weeks

Position Overview

We are seeking an experienced Utilization Review Registered Nurse (RN) to support utilization management activities within an acute care hospital setting. The ideal candidate will have recent hospital-based utilization review experience and a strong understanding of medical necessity criteria, regulatory requirements, and care coordination processes.

• Day Shift
• Weekend Requirement: Minimum of 4 weekend day shifts within a 6-week period (additional weekends may be required)

• Active California RN License required
• Pending California license accepted, but license must be active by the start date

• Minimum 3 years of acute care Utilization Review or Care Management experience in a hospital setting
• Experience must be hospital-based; health plan and medical group experience alone will not qualify
• Seasoned traveler required
• First-time travelers will not be considered

• Approximately 1:40

• Utilization Review
• Medical Necessity Review
• Concurrent Review
• InterQual and/or Milliman Guidelines
• Care Coordination
• Discharge Planning Collaboration
• Denial Prevention and Management
• Regulatory Compliance
• Clinical Documentation Review
• Electronic Medical Record Documentation

• Perform utilization review activities to ensure appropriate level of care and resource utilization
• Evaluate admissions, continued stays, and services for medical necessity
• Collaborate with physicians, case managers, and interdisciplinary teams
• Identify and address barriers to care progression and discharge
• Ensure compliance with regulatory, payer, and facility requirements
• Maintain accurate and timely documentation of utilization review activities
• Assist in denial prevention and appeals processes as needed

For more details reach at sthakur@navitashealth.com or Call / Text at 732 791 4807 - EXT 4807.