Impactful Utilization Review Nurse — Day Shift

Brundage Group; Town of Florida (NY); Hybrid; USD 90,000 - 110,000; Full time

Job summary

Brundage Group seeks an experienced Utilization Review Nurse for full-time day shifts in a hospital setting. The role requires an RN license, 5+ years in acute care, and 2+ years in utilization review. Knowledge of InterQual or MCG criteria, strong communication, and EHR proficiency are essential.

Weekend coverage and 8/10/12-hour shift options apply. The position collaborates with physicians and care teams to ensure medical necessity, appropriate status, and compliant documentation, while

Qualifications

• Current, unrestricted RN license.
• Minimum five (5) years of acute care nursing in a hospital setting.
• Minimum two (2) years of hospital-based utilization review experience.
• BSN: preferred.
• CCM/ACM/CMGT-BC: preferred.
• Proficient with InterQual or MCG criteria.
• Full-time employees may be scheduled for 8-, 10-, or 12-hour shifts.
• Ability to work independently in a fast-paced environment.
• Excellent communication skills with multiple stakeholders.
• Experience with multiple EHR and case management systems.

Responsibilities

• Conduct admission reviews to determine medical necessity and patient status.
• Perform continued stay reviews using approved clinical criteria.
• Evaluate documentation for accuracy and regulatory compliance.
• Apply InterQual and/or MCG criteria.
• Communicate findings to physicians, case management staff, and leadership.
• Collaborate with Physician Advisors on complex cases.
• Assist with denial prevention and accurate documentation.
• Work with hospital revenue cycle staff to optimize reimbursement.
• Maintain compliance with payer and regulatory standards.

Skills

RN license

Strong communication

Independent worker

Fast-paced environment

Clinical nurse experience

Education

Bachelor of Science in Nursing (BSN): preferred

Tools

InterQual

MCG

EHR systems

Job description

Brundage Group seeks an experienced Utilization Review Nurse for full-time day shifts in a hospital setting. The role requires an RN license, 5+ years in acute care, and 2+ years in utilization review. Knowledge of InterQual or MCG criteria, strong communication, and EHR proficiency are essential.

Weekend coverage and 8/10/12-hour shift options apply. The position collaborates with physicians and care teams to ensure medical necessity, appropriate status, and compliant documentation, while