Travel
Registered Nurse
Charlestown, MA
Utilization Review Nurse
Position Overview
Join a managed care organization as a Utilization Review Nurse. You'll evaluate the medical necessity, appropriateness, and efficiency of post-acute care services while ensuring alignment with evidence-based guidelines and regulatory requirements.
Key Responsibilities
- Conduct utilization reviews for inpatient rehabilitation facilities, skilled nursing facilities, and long-term acute care hospitals
- Review clinical documentation to determine medical necessity, level of care, and length of stay using approved criteria
- Perform prior authorization, concurrent, and retrospective reviews
- Collaborate with providers, case managers, and interdisciplinary teams on care planning and transitions of care
- Communicate review determinations (approvals, denials, modifications) clearly and timely to stakeholders
- Identify cases requiring escalation to Medical Directors
- Monitor ongoing cases for continued stay criteria and discharge readiness
- Ensure compliance with CMS guidelines, state and federal regulations, and accreditation standards
- Document all review activities accurately in the utilization management system
- Participate in quality improvement initiatives and audits
Required Qualifications
- Active, unrestricted RN license (any state; compact license strongly preferred)
- Bachelor of Science in Nursing (BSN) preferred
- 3–5 years of clinical nursing experience
- Previous experience in a managed care organization
- Familiarity with utilization review criteria and post-acute care settings
Preferred Skills
- Prior experience in utilization review, case management, or discharge planning
- Strong clinical assessment and critical thinking abilities
- Excellent communication and negotiation skills
- Proficiency with electronic medical records and UM systems
Work Details
- Schedule: 7:00 AM – 3:00 PM, 8-hour shifts
- Location: Remote
- Contract Duration: 13 weeks
- Start Date: November 23, 2026