Utilization Review (UR) - Critical Need

• Job Opportunity: RN – Utilization Review
• Location: Atlanta, GA
• Schedule: Day Shift | Monday–Friday | 8:30 AM – 5:00 PM
• Duration: 3+ Months (Strong possibility of extension)
• Local (W2): Up to $50/hour
• Travel: Up to $2,300/week (stipend available if >50 miles)

Role Overview:

We’re actively seeking an experienced Registered Nurse – Utilization Review to support clinical review operations in Atlanta, GA. This role plays a critical part in ensuring medical necessity, regulatory compliance, and optimized patient care outcomes. Translation: you’ll be the quality gatekeeper driving smart, efficient healthcare delivery.

Key Responsibilities:

• Perform utilization and medical necessity reviews
• Apply evidence-based criteria to determine appropriateness of care
• Collaborate with providers, case management, and interdisciplinary teams
• Ensure compliance with regulatory and payer guidelines
• Document findings clearly and accurately

Requirements:

• Active and unrestricted Registered Nurse (RN) license (Georgia or compact preferred)
• 2+ years of recent clinical nursing experience
• Prior experience in Utilization Review, Case Management, or Managed Care strongly preferred
• Strong working knowledge of medical necessity criteria (InterQual, MCG, or equivalent)
• Solid understanding of payer guidelines, CMS regulations, and utilization management processes
• Proven ability to review clinical documentation and make sound determinations on level of care
• Excellent clinical judgment, analytical, and critical-thinking skills