Utilization Review Nurse

Assignment Duration

This is a 13-week contract position.

Schedule

5x8; Monday to Friday, from 8:30 AM to 5:00 PM. No weekends or call required.

Job Description

The Utilization Review Nurse plays a critical role in facilitating utilization management processes, ensuring that patients receive appropriate care in the right setting at the right time. The nurse applies established criteria to evaluate admissions, levels of care, continued hospitalization, and readiness for care transitions. They work collaboratively with the care team to conduct concurrent reviews and proactively address any service or transition delays, while also providing clinical information to third-party payers to facilitate reimbursement.

Responsibilities

• Evaluate the appropriateness of admissions and levels of care using established criteria.
• Conduct concurrent reviews and resolve delays or issues in patient care transitions.
• Provide clinical information to payers to assure timely reimbursement.
• Communicate with physicians for necessary documentation supporting service authorization.
• Utilize InterQual and MCG evaluation criteria effectively.

Required Experience / Certifications / Licensure

• Graduate from an accredited nursing program; BSN preferred.
• Minimum of two (2) years of experience in Utilization Review.
• EPIC experience is required.
• Acute hospital experience is essential.
• Experience in Denials Management, including appeals and peer-to-peer communications is preferred.
• Current NC or compact state RN license and BLS certification required; ACM/CCM preferred.
• Travel experience is necessary.

Why ARMStaffing?

At ARMStaffing, we take care of our employees! We offer:

• Health Benefits: Medical, Dental, Vision, Life, and more
• Onboarding Made Easy: We handle physicals, titers, and more so you can focus on care
• Clinical Support: In-house clinical team available to assist and advocate
• 401k Retirement Plan: Eligible after waiting period; 4% match with 5% contribution
• Recruiter Matching: Get paired with a recruiter based on your location and specialty
• Extras: Travel reimbursement, housing allowance, meals, referral bonuses, and more

We're not the only ones who think ARMStaffing should be your first choice. Here’s why:

• SIA’s Top-50 Fastest Growing Healthcare Staffing Firms – 2019
• SIA’s Largest Healthcare Staffing Agencies in the U.S. – 2023
• Top Workplace in the Lehigh Valley – 2022, 2023
• Perfect scores for 'Name, Not a Number' and 'Recruiters' Personalities' on Highway Hypodermics
• We've earned The Joint Commission’s Gold Seal of Approval for healthcare staffing 15 years strong and counting!

Contract & local rates may vary based on location and applicant residency. Ask your ARMStaffing recruiter for details!