Acute Care, Apple, Case Management, Clinical Medicine, Clinical Practices/Protocols, Content Management Systems (CMS), Discharge Plans, Health Insurance, Health Plan, Healthcare, Healthcare Providers, Hospital, Insurance, Maintain Compliance, Patient Admissions, Patient Care, Registered Nurse (RN), Regulatory Compliance, Resource Utilization, Social Work, Time Management, Utilization Management, Willing to Travel
Job Title: Registered Nurse – Utilization Review
Location: Apple Valley, CA
Type: Contract
Position Overview:
Navitas Healthcare, LLC is seeking Registered Nurse – Utilization Review for an exciting Travel or Local job in Apple Valley, CA.
Responsibilities:
- Perform utilization review activities for inpatient admissions and continued stays
- Evaluate medical necessity using established clinical criteria and guidelines
- Collaborate with physicians, case managers, social workers, and interdisciplinary teams to support appropriate patient care and resource utilization
- Conduct concurrent reviews and identify opportunities to improve patient throughput and length of stay
- Ensure compliance with CMS, regulatory, and payer requirements
- Document utilization review findings accurately and timely
- Participate in discharge planning discussions and care coordination activities
- Monitor denials, appeals, and authorization processes as required
- Maintain communication with insurance providers and healthcare teams regarding patient status and coverage determinations
Requirements:
- Minimum 3 years of acute care Utilization Review and/or Care Management experience required
- Must have recent hospital-based utilization review experience
- Experience with health plans, insurance companies, or medical groups alone will not be considered
- Previous travel assignment experience required
- Active California Registered Nurse (RN) License required
- Pending California RN License accepted; must be active prior to start date
Preferred Qualifications:
- Seasoned traveler strongly preferred
For more details contact at hdavda@navitashealth.comor Call / Text at 516-862-1169.
About Navitas Healthcare, LLC: It is a Joint Commission Certified / WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.