Job Description

Job Title: Utilization Review (UR) – Registered Nurse

Schedule: Monday–Friday

Shift: Day Shift | 8:30 AM – 5:00 PM

Hours per Week: 40

Job Summary

We are seeking an experienced Utilization Review (UR) Registered Nurse for a temporary assignment supporting care coordination and utilization management functions. This role focuses on ensuring appropriate, high-quality, and cost-effective patient care while maintaining compliance with clinical guidelines, policies, and regulatory standards.

Key Responsibilities

• Perform utilization review to assess medical necessity and appropriateness of care
• Collaborate with physicians, case managers, and interdisciplinary care teams
• Support care coordination and transitions across the continuum of care
• Apply evidence-based guidelines and payer criteria in review decisions
• Ensure compliance with organizational policies and regulatory requirements
• Maintain accurate, timely, and complete clinical documentation
• Communicate effectively with internal teams regarding utilization outcomes

Requirements

• Active Registered Nurse (RN) license (state-specific requirements apply)
• BLS certification required
• Prior Utilization Review, Case Management, or Care Management experience preferred
• Strong clinical judgment and analytical skills
• Excellent communication, organization, and documentation abilities
• Ability to work independently and manage workload efficiently

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