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Utilization Review Registered Nurse (RN) Fully remote

Henderson, NV
About us:
Morgan Stephens represents the nation’s top healthcare systems offering the highest compensation and benefits to our top candidates.   We are created and managed by experienced industry professionals in healthcare. As a leading provider of contract, contract to perm, and direct placement recruiting services to healthcare organizations throughout the United States, we have successfully served the needs of our employees and clients by placing thousands of quality healthcare professionals into organizations seeking top talent.

 Utilization management nurses role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing patient treatment files, the utilization nurse will ensure that patients won’t receive unnecessary procedures, ineffective treatment, or unnecessarily extensive hospital stays.

Job Duties and Responsibilities:
  • Concurrent review of patient’s clinical information for efficiency
  • Ongoing review of precertification requests for medical necessity
  • Monitor the activities of clinical and non-clinical staff
  • Coordinates patient’s discharge planning needs with the healthcare team
  • Employ effective use of knowledge, critical thinking, and skills to:
    • Advocate quality care and enhanced quality of life
    • Prevent patient complications during hospital stay
    • Advocate decreased hospital stay when appropriate
  • Maintain accurate records of all patient related interactions
  • Prepare monthly patient management and cost savings report
  • Work in an intensive, fast-paced environment with minimal supervision
  • Ability to stay organized and interact well with others in any situation
  • Provide daily updates to Manager of Utilization Management for review

Skills and Qualifications:
  • Bachelor’s degree in Nursing
  • Compact license preferred 
  • Knowledge of MCG
  • State licensure as a Registered Nurse (RN)
  • required 2 years of prior experience in Utilization Management
  • Strong knowledge of word processing and spreadsheet computer programs
  • Utilization Management or Case Management certification preferred

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