Travel Nurse RN - Case Manager - $2,652 per week in Tuba City, AZ

Job Title: Utilization Review RN Profession: Nursing Specialty: Utilization Review RN Duration: 13 weeks Shift: Monday - Friday Hours per Shift: 8 am - 5 pm Experience: Minimum of 3 years of clinical nursing experience License: Current and unrestricted Professional Nursing License in any U.S. state, territory, or Commonwealth Certifications: Basic Life Support (BLS) certification by the American Heart Association (AHA) Must-Have: - Bachelor’s Degree in Nursing - Demonstrated knowledge of case management, referred care, and utilization review processes - Knowledge of electronic health record systems Description: The Utilization Review Nurse ensures that patients receive appropriate care by verifying medical necessity. They confirm the correct patient status and monitor the ongoing need for services. The role involves working to reduce unnecessary length of stay and prevent delays. They support accurate clinical documentation for proper reimbursement. The nurse coordinates with providers and the care team on discharge planning and transitions. They manage resource use to control costs and communicate with payers to prevent denials. Ensuring compliance with regulatory requirements is essential. Contributions to reporting and quality improvement efforts are also part of the position. They serve as a key liaison between clinical care, finance, and regulatory requirements. The role directly impacts patient outcomes, hospital efficiency, and the organization's financial performance.