Utilization Review RN - Evening Shift Impact

Brundage Group; Town of Florida (NY); Hybrid; USD 85,000 - 110,000; Full time

Job summary

Brundage Group in New York is seeking a Utilization Review Nurse for full-time evening shifts to conduct admission and continued stay reviews, ensuring medical necessity and payer compliance while supporting quality patient care.

You will collaborate with physicians, case managers, and care teams in a hospital setting; RN licensed, BSN preferred, and at least five years acute care experience with utilization review. Evening shifts may be 11am-11pm or 4pm-midnight, with weekend requirements.

Qualifications

• Perform hospital admission reviews to determine medical necessity and appropriate patient status.
• Conduct continued stay reviews using approved clinical criteria and guidelines.
• Evaluate clinical documentation for accuracy, completeness, and regulatory compliance.
• Apply evidence-based criteria such as InterQual and/or MCG.
• Communicate review findings and recommendations to physicians, case management staff, and leadership.
• Collaborate with Physician Advisors regarding complex cases or cases not supported by criteria.
• Assist with denial prevention activities and accurate documentation.
• Proficient in multiple Electronic Health Records and case management systems.

Responsibilities

• Perform hospital admission reviews to determine medical necessity and appropriate patient status (inpatient, observation, outpatient).
• Conduct continued stay reviews using approved clinical criteria and guidelines.
• Evaluate clinical documentation for accuracy, completeness, and regulatory compliance.
• Apply evidence-based criteria such as InterQual and/or MCG.
• Communicate review findings and recommendations to physicians, case management staff, and leadership.
• Collaborate with Physician Advisors regarding complex cases or cases not supported by criteria.
• Assist with denial prevention activities and accurate documentation.

Job description

Brundage Group in New York is seeking a Utilization Review Nurse for full-time evening shifts to conduct admission and continued stay reviews, ensuring medical necessity and payer compliance while supporting quality patient care.

You will collaborate with physicians, case managers, and care teams in a hospital setting; RN licensed, BSN preferred, and at least five years acute care experience with utilization review. Evening shifts may be 11am-11pm or 4pm-midnight, with weekend requirements.