Utilization Review RN - Part-Time with Shift Differentials

SmartRecruiters, Inc.; Ellensburg (WA); On-site; USD 62,000 - 110,000; Part time

Benefits offered by this job

Benefits eligible

Shift differentials

Union (WSNA)

Job summary

KVH is seeking a Utilization Review (UR) RN to evaluate medical necessity and ensure efficient care in a hospital setting. The UR RN coordinates pre-authorizations, confirms medical necessity, and collaborates with clinical teams and payers to support appropriate care transitions.

Based in Washington, this 0.7 FTE role offers shift differentials and a benefits-eligible, union-covered environment. Cerner EHR experience is preferred.

Qualifications

• Graduate of an accredited nursing program with active WA RN license or MSL with WA endorsement.
• Minimum 3 years of clinical nursing experience in acute care.
• Experience with InterQual or MCG guidelines and CMS participation basics.
• Familiarity with CMS Conditions of Participation and health insurance billing requirements.

Responsibilities

• Evaluate medical necessity, appropriateness, and efficiency of healthcare services using criteria to support CMS compliance.
• Facilitate timely insurance pre-authorizations and confirm medical necessity to prevent denials.
• Collaborate with clinical teams, case management, and payers to optimize care transitions and reimbursement.
• Monitor length of stay and report trends to Utilization Review Committee; assist with denial investigations.

Skills

Clinical nursing experience

Evidence-based care guidelines

CMS/insurance billing knowledge

InterQual/MCG familiarity

Education

WA RN license or MSL with WA endorsement

Tools

Cerner EHR

Job description

KVH is seeking a Utilization Review (UR) RN to evaluate medical necessity and ensure efficient care in a hospital setting. The UR RN coordinates pre-authorizations, confirms medical necessity, and collaborates with clinical teams and payers to support appropriate care transitions.

Based in Washington, this 0.7 FTE role offers shift differentials and a benefits-eligible, union-covered environment. Cerner EHR experience is preferred.