Registered Nurse (RN) - Utilization Review - PRN

Azza HealthCare Agency; Austell (GA); On-site; USD 60,000 - 85,000; Part time

Job summary

Azza HealthCare Agency is seeking an Utilization Management Nurse Coordinator to perform 24/7 medical necessity reviews, secure authorizations, and coordinate safe transitions of care. The role requires RN licensure, BLS, and 3+ years of clinical practice.

Responsibilities include working with payers and clinicians, documenting in EPIC, and ensuring compliant billing processes. This PRN on-site position offers flexible shifts including holidays and opportunities to mentor junior staff.

Qualifications

• RN license (single-state or compact)
• 3+ years clinical practice
• BLS certification required
• Knowledge of case management, clinical criteria, and documentation standards
• Excellent verbal and written communication, organizational, and critical thinking skills

Responsibilities

• Perform clinical reviews using established criteria for admissions, observation, and ongoing care.
• Coordinate with payers, physicians, and care teams to secure timely authorizations and resolve discrepancies pre-billing.
• Document all review activities accurately in electronic systems like EPIC and communicate effectively with stakeholders.
• Monitor patient care plans, evaluate appropriateness of care, and advocate for patients outside coverage if needed.
• Support compliance with regulations, participate in performance improvement initiatives, and mentor staff.

Skills

Clinical review

Communication

Organizational

Critical thinking

Documentation

Education

RN license

BLS certification

Tools

EPIC

Billing systems

Job description

Role: Utilization Management Nurse (UM) Coordinator, responsible for conducting 24/7 medical necessity reviews, obtaining authorizations, and facilitating safe transitions of care.

Key Responsibilities

• Perform clinical reviews using established criteria (e.g., MCG, mcg Indicia) for admissions, observation, and ongoing care.
• Coordinate with payers, physicians, and care teams to secure timely authorizations and resolve discrepancies pre-billing.
• Document all review activities accurately in electronic systems like EPIC and communicate effectively with stakeholders.
• Monitor patient care plans, evaluate appropriateness of care, and advocate for patients outside coverage if needed.
• Support compliance with regulations, participate in performance improvement initiatives, and serve as a mentor or preceptor.

Qualifications & Skills

• Minimum of 3 years clinical practice experience.
• RN license (single-state or multi-state compact) and BLS certification required.
• Strong knowledge of case management, clinical criteria, and documentation standards.
• Excellent verbal and written communication, organizational, and critical thinking skills.
• Proficient in clinical data review, utilizing screening criteria, and computer systems.

Additional Info: This PRN role involves working various shifts, including holidays, with responsibilities centered on clinical review, documentation, and collaboration to ensure appropriate care and billing processes.