Travel Nurse RN – $1,800 per week in Camden, ME Position Available In Camden, New Jersey

Job Description:

TravelNurseSource is working with Magnet Medical to find aqualified Other RN in Camden, Maine, 04843! Pay Information $1,800per week About The Position The Registered Nurse (RN) – UtilizationReview (UR) is responsible for ensuring that healthcare servicesprovided to patients are medically necessary, appropriate, andefficient. The RN in this role works with healthcare providers,insurance companies, and patients to review medical records,treatment plans, and clinical data to determine the appropriatelevel of care and ensure compliance with healthcare policies andregulations. This role requires a strong understanding of clinicalcare, health insurance guidelines, and hospital operations to makeinformed decisions that optimize patient care and resourceutilization.

Key Responsibilities :

Utilization Review and ClinicalEvaluation :

Review patient medical records, treatment plans, andclinical data to assess the appropriateness of the care beingprovided and the necessity for continued hospitalization orservices. Assess the medical necessity of procedures, tests, andtreatments to ensure they align with established guidelines andcriteria, such as those from the InterQual or Milliman CareGuidelines . Evaluate whether the care provided is appropriate,efficient, and meets the standards of care based on clinicalevidence. Collaboration with

Healthcare Providers :

Collaboratewith physicians, case managers, and other healthcare professionalsto ensure that patient care plans are appropriate andcost-effective. Communicate with healthcare teams to discuss anydiscrepancies or concerns regarding the utilization of resources,care plans, or treatment goals. Provide recommendations oralternative care options to improve patient outcomes and optimizeresource utilization.

Insurance and Payer Interaction :

Workclosely with insurance companies, managed care organizations, andgovernment payers (e.g., Medicare, Medicaid) to review cases forcoverage, authorization, and reimbursement. Submit necessarydocumentation and justification to insurance companies to supportmedical necessity determinations and secure prior authorization fortreatments, procedures, or extended hospital stays. Resolve anyissues related to denied claims or requests for additionaldocumentation to ensure that services are covered by insuranceproviders.

Monitoring of Length of Stay and Discharge Planning :

Monitor patient length of stay (LOS) to identify potential delaysin discharge and ensure that patients are not staying in thehospital longer than necessary. Work with case management teams todevelop appropriate discharge plans, ensuring that the patient isready for discharge and has the necessary resources and follow-upcare. Identify potential barriers to discharge and collaborate withthe interdisciplinary team to address these issues and facilitate atimely discharge.

Compliance and Quality Assurance :

Ensure thatutilization review practices comply with regulatory standards,including The Joint Commission (TJC), Centers for Medicare &Medicaid Services (CMS), and other state or federal regulations.

Assist with audits to evaluate the efficiency and accuracy ofutilization management processes, making improvements wherenecessary. Maintain up-to-date knowledge of healthcare regulations,coding guidelines (ICD-10, CPT), and payer-specific policies toensure accurate documentation and compliance.

Documentation andReporting :

Document findings from utilization reviews in theappropriate systems and ensure accurate record-keeping forinsurance purposes and quality improvement efforts. Prepare reportson utilization metrics, including patterns in hospital admissions,readmissions, and discharge delays, for management and leadershipreview. Provide detailed, evidence-based rationales for medicalnecessity determinations and collaborate with the healthcare teamto ensure compliance with UR protocols.

Case Review andDecision-Making :

Perform retrospective and concurrent review ofpatient cases to determine if the level of care aligns withguidelines and if resources are being utilized efficiently.

Recommend the appropriate level of care (e.g., inpatient,outpatient, skilled nursing facility) based on clinical findingsand guidelines. Provide feedback to clinicians and healthcare teamsregarding any areas for improvement in care planning or resourceutilization.

Education and Training :

Educate staff and providerson the importance of utilization review processes, medicalnecessity criteria, and compliance with payer requirements. Staycurrent on the latest healthcare policies, clinical guidelines, andbest practices for utilization management. Participate incontinuing education and training programs related to UR, casemanagement, or quality improvement initiatives. 27812314EXPPLATAbout Magnet Medical We are new and nimble! Even though our companyis new we have over 30 years of experience in the HealthcareStaffing world. We have taken all the exceptional things we’velearned over the years and put them into Magnet MEdical. We arecommitted to providing the best Quality, Care, Service and Supportto those who are providing care to the patients. We work withHospitals and Skilled Nursing Facilities across all 50 states. Wecan’t do our jobs without you so let’s work together to help youmeet all of your goals! We have recently merged two staffingcompanies to create Magnet Medical which allows us to offer moreopportunities to our travelers!

Modalities we staff:

RegisteredNurses LPN/LVN PT’s and PTA’s OT’s and COTA’s SLP Surgical Tech’sSterile Processing Tech’s Since we are new and nimble, we are notset in our ways so that we can be flexible to our candidate andclient needs. We are here when you need us!