TravelNurseSource is working with Highland Staffing, LLC to find a qualified Other RN in Tuba City, Arizona, 86045!
Job Title
Utilization Review Registered Nurse (RN)
Job Summary
Tuba City Regional Health Care Corporation, a JCAHO accredited 73-bed facility, is seeking a dedicated Utilization Review Registered Nurse for a 13-week contract. Located in Northwestern Arizona on the culturally rich Colorado Plateau, the hospital serves a vast 4,400 square mile area, acting as a referral center for the western Navajo and Hopi Reservations. This diverse community offers a unique and rewarding environment for healthcare professionals.
The Utilization Review RN plays a critical role in ensuring patients receive appropriate, high-quality care while optimizing hospital resources. This position involves verifying medical necessity, confirming correct patient status, and proactively monitoring the ongoing need for services to reduce unnecessary length of stay and prevent delays. The successful candidate will be a key liaison between clinical care, finance, and regulatory requirements, directly impacting patient outcomes, hospital efficiency, and financial performance.
Key Responsibilities
- Verify medical necessity for patient admissions and ongoing services.
- Confirm appropriate patient status (e.g., inpatient, observation).
- Monitor the ongoing need for services to reduce unnecessary length of stay and prevent delays.
- Support accurate clinical documentation to ensure proper reimbursement.
- Coordinate with providers and the interdisciplinary care team on discharge planning and transitions of care.
- Manage resource utilization to control costs effectively.
- Communicate with payers to prevent claim denials.
- Ensure compliance with Centers for Medicare & Medicaid Services (CMS) and Joint Commission requirements.
- Contribute to reporting and quality improvement initiatives.
- Align patient care with established quality standards and reimbursement rules.
Required Qualifications
- Bachelor’s Degree in Nursing (BSN).
- Three (3) years of clinical nursing experience performing direct patient care.
- At least two (2) years of clinical experience in an Inpatient setting (Medical-Surgical, PACU, ICU, Step-Down, Telemetry, etc.) or home health (direct care).
- Current Basic Life Support (BLS) certification by the American Heart Association (AHA).
Preferred Qualifications
Not specified.
Skills & Competencies
- Strong knowledge of utilization review processes and principles.
- Familiarity with case management and purchased/referred care processes.
- Proficiency in electronic health record (EHR) systems.
- Excellent communication and interpersonal skills for collaborating with providers, care teams, and payers.
- Ability to analyze medical documentation and apply clinical criteria effectively.
- Strong organizational and time management skills.
- Commitment to quality improvement and regulatory compliance.
Shift Details
- Shift Type: Day Shift (AM)
- Hours: 8:00 AM - 5:00 PM
- Days per Week: 5 days
- Contract Length: 13 weeks
- Start Date: September 7, 2026
- Call Requirements: Not specified.
- Weekend Rotations: Not specified.
Licensing Requirements
- A valid, current, full, and unrestricted Professional Nursing License to practice as a Registered Nurse (RN) in any state of the United States of America, The Commonwealth of Puerto Rico, or a territory of the United States. (Note: An Arizona state license is not required for this facility).
- Current Basic Life Support (BLS) certification by the American Heart Association (AHA).