[Hiring] Utilization Review RN @HealthPlus Staffing

Role Description

• Conduct admission, continued stay, and observation reviews
• Apply medical necessity criteria to determine appropriate level of care
• Review cases for Physician Advisor escalation when appropriate
• Collaborate with physicians, case managers, and insurance payers
• Support denial prevention, documentation improvement, and revenue cycle initiatives
• Ensure compliance with payer guidelines and regulatory requirements
• Analyze clinical and financial data to identify quality improvement opportunities

Qualifications

• Active RN license with Multi-State/Compact license required
• Minimum 2 years of Utilization Review experience
• Minimum 3 years of clinical nursing experience (acute care/hospital preferred)
• Strong understanding of medical necessity, utilization management, healthcare reimbursement, and clinical documentation improvement
• Excellent communication, analytical, and critical thinking skills
• Ability to work independently in a remote environment

Benefits

• Comprehensive benefits package

Company Description

HealthPlus Staffing is a national leader in the healthcare staffing industry. We partner with top healthcare organizations nationwide to connect highly qualified professionals with outstanding career opportunities.