Registered Nurse – Utilization Review (RN UR)

Job Title: Registered Nurse – Utilization Review (RN UR)
Job Location: Atlanta, GA 30305
Duration: 3 Months+ of Contract (Possibility of Extension)

Shift: Day Shift (08:30 AM to 05:00 PM)

Job Summary:
The Registered Nurse – Utilization Review (RN UR) is responsible for reviewing medical records and clinical documentation to ensure appropriate utilization of healthcare services. This role ensures compliance with regulatory requirements, payer guidelines, and organizational policies while promoting quality, cost-effective patient care.
 
Key Responsibilities:

• Conduct utilization reviews for inpatient, outpatient, and/or post-acute services
• Assess medical necessity, level of care, length of stay, and appropriateness of services
• Apply evidence-based criteria (InterQual, MCG, Milliman, etc.)
• Perform concurrent, retrospective, and/or prospective reviews
• Collaborate with physicians, case managers, and interdisciplinary teams
• Initiate prior authorizations and concurrent reviews with payers
• Identify and escalate potential denials and assist with appeals
• Ensure compliance with CMS, NCQA, Joint Commission, and payer guidelines

 
Required Qualifications:

• Active Registered Nurse license
• Minimum 1 years of clinical RN Utilization Review experience
• Post Acute / SNF exp required

 
Certifications:

• BLS AHA (required)