Registered Nurse (RN) - Utilization Management (UM)

RN - Utilization Management (UM)\n\nTLC Nursing Associates, Inc.\n\nTLC Nursing Associates, Inc. is seeking a skilled and detail-oriented Registered Nurse – Utilization Management (UM) to review healthcare services, ensure clinical appropriateness, and coordinate effective patient care within regulatory guidelines.\n\nJob Responsibilities\n

• Review patient medical records, treatment plans, and diagnostic information to assess the necessity and appropriateness of care.\n
• Collaborate with healthcare providers, insurance companies, and case managers to facilitate approval of services.\n
• Ensure compliance with clinical guidelines, payer policies, and regulatory standards.\n
• Analyze utilization data and identify opportunities for care improvement and cost containment.\n
• Communicate utilization decisions and provide education to providers and patients regarding coverage and care options.\n
• Document all review activities accurately and maintain patient confidentiality.\n
• Support quality assurance initiatives related to utilization management processes.\n\nQualifications\n
• Current Registered Nurse (RN) license in the state of practice.\n
• Experience in utilization management, case management, or clinical review preferred.\n
• Strong clinical assessment, critical thinking, and decision-making skills.\n
• Knowledge of healthcare regulations, insurance processes, and clinical guidelines.\n
• Excellent communication, organizational, and interpersonal skills.\n
• Ability to work independently and as part of a multidisciplinary team.\n\nBenefits\n
• Competitive pay and flexible contract options.\n
• Comprehensive medical, dental, and vision insurance plans.\n
• Opportunities for professional growth and continuing education.\n
• Supportive work environment with 24 / 7 access to a dedicated staffing and clinical liaison team.\n\nIf you are a detail-focused and compassionate RN – Utilization Management (UM), apply today and join the TLC Nursing Associates family!