Job Title: RN - Utilization Review
Location: New York, NY
Job Type: Contract
Duration: 8 Weeks
Shift: Day Shift | 9:00 AM – 5:00 PM
Schedule: Monday–Friday | 8 hours/day
Local Candidates Required: Yes
Traveler Candidates Required: Yes
Pay Rate: $61 to $71/hr
Required Qualifications
- Current New York State RN License required.
- Primary Source Verification of RN license required.
- Current AHA BLS Certification required.
- Minimum 1 year of non-acute Utilization Review experience required.
- RN experience preferred.
- Experience with Community Nursing preferred.
- Experience with Quality Improvement preferred.
- Strong clinical documentation and review skills.
- Ability to assess medical necessity and appropriateness of patient care.
- Strong communication, analytical, and organizational skills.
Responsibilities
- Perform utilization review activities for assigned patient cases.
- Review patient medical records and clinical documentation.
- Assess the appropriateness and medical necessity of services provided.
- Apply established utilization review criteria and healthcare guidelines.
- Collaborate with physicians, nurses, case managers, and other healthcare professionals.
- Identify potential issues related to quality, utilization, and patient care.
- Support quality improvement initiatives and identify opportunities for improved patient outcomes.
- Maintain accurate and timely documentation of utilization review activities.
- Communicate findings and recommendations to appropriate members of the healthcare team.
- Follow organizational policies, procedures, and applicable regulatory requirements.
- Utilize clinical knowledge and nursing judgment when reviewing patient cases.
- Perform other related duties as assigned.
