RN - Utilization Review - New York, NY - JS26-12309

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.