Job Title: RN - Utilization Review
Location: Syracuse, NY
Type: Contract | 14 Weeks
Shift & Schedule: Day Shift | Full-Time | Monday–Friday
Position Overview:
Navitas Healthcare, LLC is seeking RN - Utilization Review for an exciting Travel or Local job in Syracuse, NY.
Responsibilities
- Conduct utilization review activities for inpatient admissions and continued stays
- Review medical records to determine medical necessity and appropriate level of care using established screening criteria
- Ensure compliance with CMS regulations, payer requirements, and hospital policies
- Collaborate with physicians, case managers, nursing staff, and payers regarding authorization and care coordination
- Interface with healthcare payers and regulatory agencies regarding patient status and reimbursement requirements
- Monitor admission status, discharge planning, and length of stay management
- Maintain accurate and timely documentation within the electronic medical record system
- Participate in quality improvement and performance initiatives related to utilization management
- Identify and escalate cases requiring physician advisor review or additional clinical documentation
- Support denial prevention and appeal processes when necessary
Requirements
- Current New York State RN License required
- Current BLS Certification required
- Minimum 1.5 years of recent acute care hospital experience within the last 2 years required
- Strong clinical assessment, critical thinking, and analytical skills
- Excellent verbal and written communication skills
- Ability to work independently and collaboratively in a fast-paced healthcare environment
Preferred Qualifications
- Utilization Review, Utilization Management, or Case Management experience preferred
- Experience with MCG or InterQual screening tools preferred
- Knowledge of CMS regulations related to hospital admissions and utilization review preferred
- Experience interfacing with healthcare payers and regulatory agencies preferred
- EPIC EMR experience preferred
- Experience with payer authorization processes and denial management preferred
- Trauma center or large hospital experience preferred
For more details contact at [email protected] or Call / Text at 516-862-1169.
About Navitas Healthcare, LLC: It is a Joint Commission Certified / WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.
