RN – Utilization Review
Location: East Elmhurst, NY
Employment Type: Contract – 13 Weeks
Pay Rate
- Travel: $2,550–$2,630 per week
- Local: $69–$73 per hour
Position Summary
We are seeking a Registered Nurse (RN) – Utilization Review to evaluate healthcare services for medical necessity, appropriateness, and compliance with established clinical guidelines.
The ideal candidate will have experience in non-acute utilization review, along with strong clinical documentation and medical record review skills.
Key Responsibilities
- Perform utilization review of healthcare services and medical records.
- Assess medical necessity and appropriateness of requested services.
- Review clinical documentation against established criteria and guidelines.
- Identify gaps, discrepancies, or inconsistencies in clinical documentation.
- Collaborate with providers, care management teams, and other healthcare professionals.
- Communicate utilization review decisions and requests for additional clinical information.
- Maintain accurate and timely documentation of utilization review activities.
- Ensure compliance with organizational, regulatory, and payer requirements.
Required Qualifications
- Minimum 1 year of non-acute utilization review experience – Required
- Active New York State RN License – Required
- AHA BLS Certification – Required
- Primary Source Verification – Required
Required Skills
- Utilization Review
- Registered Nurse (RN) Experience
- Medical Necessity Review
- Clinical Documentation Review
- Care Management
BENEFITS: This position does not offer any additional benefits.
