Job Title: Utilization Review Registered Nurse (Day Shift)

We're looking for a local Registered Nurse with a TX RN Compact license to join our team in a temporary•to•permanent Utilization Review role.

The successful candidate will be responsible for assessing the clinical appropriateness of patient care and ensuring efficient resource utilization. This includes conducting pre•admission, concurrent, and retrospective reviews in line with approved screening criteria (InterQual/MCG/CMS Inpatient List).

Key responsibilities include managing a diverse workload in a fast•paced environment, staying updated with commercial and government payor regulations, effectively communicating with clinical professionals, organizing patient financial insurance care, and collaborating with the healthcare team.

The ideal candidate will demonstrate clinical competency and judgment, perform comprehensive assessments of clinical information and treatment plans, and apply medical necessity criteria to determine the appropriate level of care. They will also assess the assigned patient population for medical necessity, level of care, and appropriateness of setting and services, using MCG/InterQual Care Guidelines and/or health system approved tools.