The Travel Utilization Review RN reviews medical records to assess the medical necessity of hospital admissions and continued stays. They collaborate with healthcare providers and insurers to ensure compliance with insurance guidelines and support effective discharge planning. This role requires at least 2 years of experience in utilization review or case management and an active RN license.
Prime Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Arcata, California.
Job Description & Requirements About the Position
Specialty: RN – Utilization Review
Experience: 2+ years of experience in utilization review, case management, or acute care nursing
License: Active State or Compact RN License
Certifications: BLS – AHA; Certified Case Manager (CCM) preferred
Must-Have: Strong understanding of insurance guidelines, medical necessity criteria (e.g., InterQual or MCG), and discharge planning
Description: The Utilization Review RN is responsible for reviewing medical records to determine the appropriateness and medical necessity of hospital admissions and continued stays. The nurse collaborates with providers, insurance companies, and case managers to ensure compliance with coverage guidelines and supports optimal patient outcomes while managing healthcare costs.
Requirements
Required for Onboarding:
Prime Staffing Job ID #33512499. Pay package is based on 8 hour shifts and 40.0 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN:Utilization Review,08:00:00-16:00:00
About Prime StaffingAt Prime Staffing, we understand the importance of finding the perfect fit for both our clients and candidates. Prime Staffing utilizes a unique matchmaking approach, providing the most qualified contingent staffing to our clients, and the most competitive contracts to our workforce. Our experienced team takes the time to get to know both our clients and candidates, their needs, and preferences, to ensure that each placement is a success.
We offer a wide range of staffing services including temporary, temp-to-perm, and direct hire placements. Our extensive network of qualified candidates includes nurses, allied healthcare professionals, corporate support professionals and executives.
utilization review, travel nurse, case management, registered nurse, medical necessity, insurance guidelines, discharge planning, acute care nursing, healthcare compliance, patient outcomes
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