Travel Registered Nurse - Utilization Review in Mifflinville, PA

Job Description: Travel Registered Nurse - Utilization Review We are seeking a highly analytical and experienced Travel Registered Nurse - Utilization Review to join our healthcare team. As a Travel Registered Nurse - Utilization Review, you will evaluate patient care services to ensure that medical necessity, quality standards, and regulatory guidelines are consistently met across multiple facilities. This travel role offers a unique opportunity to combine clinical expertise with administrative excellence. Key Responsibilities: • Clinical Review and Assessment: Perform utilization reviews of patient records to ensure appropriate hospital admissions, medical necessity, continued stay, and discharge planning. Travel Registered Nurses - Utilization Review must apply strong clinical judgment. • Care Coordination: Collaborate with physicians, case managers, payers, and care teams to support safe and efficient patient care pathways. • Insurance and Documentation Review: Review clinical documentation for completeness and accuracy before submitting to insurance providers for authorization and reimbursement purposes. • Regulatory Compliance: Ensure compliance with federal, state, and health plan regulations. Travel Registered Nurses - Utilization Review must stay updated on industry guidelines. • Denial Management: Assist in appealing denials by providing clinical rationale and supporting documentation. • Patient Advocacy: Promote equitable access to care while ensuring appropriate resource use and cost-effective services. • Travel Responsibilities: Adapt quickly to new healthcare settings while maintaining consistent review standards across facilities. Requirements: • Valid Registered Nurse (RN) license. • Minimum 2 years' experience in utilization review, case management, or acute care nursing. • Strong knowledge of medical necessity criteria (InterQual, MCG, CMS guidelines). • Excellent critical thinking, decision-making, and communication skills. • Ability to work independently and manage detailed documentation. • Willingness to travel for temporary assignments. Benefits: • Competitive travel RN pay packages. • Paid time off and flexible schedules. • Career growth opportunities in clinical administration. Qualifications: • RN license in good standing. • UR/UM/Case Management experience preferred. • Familiarity with payer requirements and authorization processes. • Strong organizational skills and attention to detail. If you're an experienced RN who excels in clinical analysis and wants to expand your career through travel opportunities, apply today to join our team as a Travel Registered Nurse - Utilization Review! Keywords: Travel Registered Nurse jobs near me, Travel RN jobs near me, Nurse jobs near me, Travel Nurse jobs near me, RN jobs near me, Healthcare jobs near me.