Registered Nurse (RN) | Utilization ReviewLocation: Camden, MEAgency: Bluebix Health IncPay: $55 to $60 per hourShift Information: Days - 5 days x 8 hoursContract Duration: 10 WeeksStart Date: ASAP
Shift: 7:00 AM to 3:30 PM
Contract Weeks: 10
Guaranteed Hours: 40
Job Summary
The RN Utilization Management (UM) Nurse is responsible for reviewing and evaluating the medical necessity, appropriateness, and efficiency of healthcare services. This role ensures optimal patient outcomes while maintaining compliance with payer guidelines, regulatory standards, and cost-effective care delivery.
Key Responsibilities
Review patient medical records to assess medical necessity and level of care
Perform utilization reviews (prospective, concurrent, and retrospective)
Ensure compliance with payer guidelines, CMS regulations, and facility policies
Collaborate with physicians, case managers, and care teams to optimize patient care plans
Identify and address overutilization or underutilization of services
Initiate and manage authorization requests and denials/appeals
Communicate with insurance providers regarding coverage and approvals
Maintain accurate documentation in UM systems and EMR/EHR
Participate in quality improvement and cost-containment initiatives
Required Qualifications
Active Registered Nurse (RN) license in the state of practice
Minimum 2–3 years of clinical nursing experience
Experience in Utilization Management, Case Management, or Care Coordination
Strong knowledge of payer guidelines (Medicare, Medicaid, commercial)
Current BLS certification
RN ME or Compact License
BLS