RN – Utilization Management (UM) - RNUM

NavitasPartners • Pembroke, NC

1d • $50 - $56

About The Position

We are seeking a skilled Registered Nurse (RN) with Utilization Management experience for a 9-week contract assignment in Pembroke, NC. The RN – UM will be responsible for reviewing admissions, ensuring medical necessity, coordinating payer communications, and maintaining compliance with regulatory requirements. This role requires strong knowledge of Medicare, Medicaid, managed care processes, and CMS guidelines.

Requirements

• Active Registered Nurse (RN) license.
• Current BLS (Basic Life Support) certification.
• Experience in Utilization Management, Case Management, or Skilled Nursing review processes preferred.
• Strong understanding of Medicare/Medicaid guidelines and payer requirements.

Responsibilities

• Review admissions for medical necessity and appropriate level of care.
• Verify insurance coverage and obtain required prior authorizations.
• Communicate with insurance providers regarding approvals, denials, and appeals.
• Monitor resident length of stay and determine skilled coverage eligibility.
• Coordinate Medicare, Medicaid, and managed care documentation requirements.
• Conduct concurrent reviews to support continued stay justification.
• Track and manage skilled nursing days and benefit periods.
• Prepare and submit accurate clinical documentation to payers.
• Ensure compliance with CMS regulations and state guidelines.

What This Job Offers

• Career Level: Mid Level
• Education Level: No Education Listed