RN Utilization Review Nurse

Healthcare Support Staffing; Troy (MI); On-site; USD 45,460 - 50,971; Full time

Job summary

A national healthcare staffing firm seeks an experienced RN Utilization Review Nurse in Troy, MI. Responsibilities include utilization review for Medicaid and Medicare, managing authorization processes, and collaborating with healthcare teams to ensure quality care. Ideal candidates must possess an RN license and have at least two years of clinical experience. This role offers a salary between $33 – $37 per hour, Monday to Friday, in a fun, positive work environment.

Qualifications

• Must be an RN.
• Minimum one year in Utilization Review or managed care.
• Familiarity with Interqual for at least one year.
• Experience in patient facilities, rehab, or home healthcare.
• Proficiency in Microsoft Office and data entry.
• Preferably hospital nursing or case management.

Responsibilities

• Provide utilization review for Medicaid and Medicare.
• Work with Utilization Management team on medical necessity.
• Conduct daily reviews for hospitalization and authorizations.
• Handle provider appeals and assist with denial letters.
• Identify members' expected length of stay and procedures.
• Collaborate with departments for continuity of care.

Skills

Utilization Review background

Interqual experience

Microsoft Office

Data Entry

Clinical practice

Typing skills

Education

RN license

Minimum 2-4 years clinical practice

Job description

HealthCare Support Staffing, Inc. (HSS), is a proven industry‑leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non‑clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long‑lasting and rewarding career!

Job Description

Are you an experienced RN Utilization Review Nurse looking for a new opportunity with a prestigious healthcare company as a RN Utilization Review Nurse. Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes” to any of these questions – this is the RN Utilization Review Nurse position for you!

Company Job Description/Day to Day Duties:

• Providing utilization review for the Medicaid and Medicare line of business. Primarily inpatient, skilled nurses facilities, rehab, behavioral health, and home healthcare.
• Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines
• Provider appeals and Utilization reviews and assist with Denial Letters
• Provides concurrent review and prior authorizations (as needed) according to policy for members as part of the Utilization Management team.
• Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.
• Participates in interdepartmental integration and collaboration to enhance the continuity of care for members including Behavioral Health and Long Term Care.

Hours for this Position:

• Mon‑Fri: 8:30am – 5pm

Advantages of this Opportunity:

• Great salary between $33 – 37!
• Fun and positive work environment!

Qualifications

Minimum Education/Qualifications/Licensures:

• Must be an RN
• Utilization Review background in either Managed Care of Provider environment (at least one year)
• Interqual experience (at least one year)
• Also has a background in patient, skilled nurses facilities, rehab, and home healthcare.
• Other basic computer skills necessary: Microsoft Office, Data Entry, etc.
• Minimum 2‑4 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management.
• Great typing and data entry skills

Additional Information

Interested in being considered?

If you are interested in being considered for this position, please click the apply button below. Or call John Wood 407-478-0332 ext 225