RN - Utilization Review (UR)

RN – Utilization Review (UR)

Location: Atlanta, GA (Onsite – No home visits are required) Contract: 13 Weeks Shift: Days | 8:30 AM – 5:00 PM Pay rate: $70/hr. on W2

We are seeking an experienced Utilization Review Registered Nurse (UR RN) to support the Care at Home – Home Health program. This position focuses on reviewing patient cases to ensure appropriate utilization of healthcare services, regulatory compliance, and quality patient outcomes.

Key Responsibilities

• Perform utilization review for Home Health patients to ensure appropriate level of care.
• Review clinical documentation for medical necessity, insurance authorization, and compliance with regulatory guidelines.
• Collaborate with physicians, case managers, and interdisciplinary teams to optimize patient care plans.
• Monitor patient progress and recommend appropriate levels of care and service utilization.
• Maintain accurate documentation in the electronic medical record.
• Ensure compliance with CMS, payer, and organizational policies.
• Communicate effectively with internal teams regarding authorization status and care coordination.
• Support quality improvement initiatives and utilization management goals.

Requirements

• Active Registered Nurse (RN) License.
• Previous Utilization Review (UR) experience required.
• Home Health and/or Care Management experience preferred.
• Strong knowledge of medical necessity criteria, utilization management, and clinical documentation review.