Utilization Review RN

LabMinds Staffing & Recruiting • Tuba City, AZ

1d • Onsite

About The Position

The Utilization Review (UR) Nurse serves as a key liaison between clinical care, finance, and regulatory compliance. This role verifies medical necessity, monitors patient care needs, ensures proper clinical documentation for reimbursement, and works to reduce length of stay and avoid care delays. The UR Nurse manages resource utilization, prevents payer denials, and ensures adherence to CMS and Joint Commission standards to support organizational efficiency and patient outcomes.

Requirements

• Bachelor’s Degree in Nursing (BSN) required.
• Active, full, and unrestricted RN license in any US state, territory, or Puerto Rico.
• Current American Heart Association (AHA) Basic Life Support (BLS) required throughout employment.
• Minimum 3 years of clinical nursing experience in direct patient care.
• At least 2 years in an inpatient setting (Med/Surg, PACU, ICU, Step-Down, Telemetry, etc.) or direct-care home health setting.
• Demonstrated knowledge of Utilization Review, Case Management, and Purchased Referred Care (PRC) processes.
• Proficiency with Electronic Health Record (EHR) systems.

Responsibilities

• Verify medical necessity, confirm correct patient status, and monitor ongoing service needs to reduce unnecessary length of stay.
• Coordinate with providers and interdisciplinary teams on resource management, discharge planning, and seamless care transitions.
• Review and support accurate clinical documentation to ensure appropriate reimbursement and communicate with payers to prevent coverage denials.
• Ensure all utilization practices align with CMS, Joint Commission, and organizational standards.
• Participate in clinical reporting, auditing, and quality improvement initiatives.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level