Registered Nurse; RN - Utilization Review

Medical Solutions Direct Hire is seeking a Registered Nurse (RN) Utilization Review for a nursing job in White Plains, New York.

• Specialty:
  Utilization Review
• Discipline:
  RN
• Start Date:
  
  ASAP
• Duration:
  Ongoing
• 37 hours per week
• Shift:
  12 hours, days
• Employment Type:
  
  Staff

Job Description

RN Care Manager Opportunity – White Plains, NY

Direct Hire | Full-Time | Day Shift

A leading acute-care healthcare organization in White Plains, NY is seeking an experienced RN Care Manager for a permanent, full-time position. This role offers a predictable weekday schedule with limited weekend rotation and a strong compensation package in a collaborative care management environment.

· Permanent, direct-hire role

· Acute care hospital setting

· Case Management / Utilization Review department

· Full-time position (37.5 hours per week)

· Day shift

· Monday–Friday schedule

· EPIC electronic medical record system

· One position available

· ASAP start

· Monday–Friday, 9:00am–5:00pm

· Weekend rotation: one Saturday and Sunday per month

· Guaranteed hours: 37.5 per week

· No on-call requirements

· Salary range: $ – $ annually

· Hourly rate: $64.70 – $82.10

· Full suite of benefits

· Retirement plan

· Perform comprehensive initial assessments upon admission in accordance with Care Management policies

· Screen patients using established high-risk indicators to identify discharge planning and support needs

· Provide ongoing reassessment throughout the patient’s hospital course

· Coordinate multidisciplinary care at both intra-hospital and inter-hospital levels

· Lead transitional care planning activities, including:
o Patient and caregiver education
o Arrangement of post-acute and aftercare services
o Commercial payer coordination
o High-utilizer patient root cause analysis

· Communicate relevant patient information to interdisciplinary healthcare team members

· Support departmental goals related to length of stay reduction, readmission prevention, denial reduction, and patient satisfaction

· Perform utilization review (UR) activities per department policy, including:
o Commercial payer reviews
o Admission clinical reviews
o Disposition determinations
o Retro and self-audits
o Medical necessity variance documentation

· Collaborate with healthcare professionals to evaluate and ensure safe discharge planning for geriatric patients across inpatient, emergency, and surgical outpatient settings

· Maintain accurate documentation in compliance with department requirements

· Participate in performance improvement initiatives

· Perform additional duties as assigned

· Active New York State Registered Nurse (RN) license (Required)

· BSN required (MSN preferred)

· PRI Certification (must be obtained within 3 months of hire)

· Screen certification strongly preferred

· Care Management certification preferred (CMC, CCM, or similar)

· Minimum of 3 years of clinical experience in ED, critical care, or medical-surgical nursing preferred

· Previous case management experience preferred

· Experience with Milliman/Inter Qual criteria required

· Knowledge of healthcare financial, regulatory, and payer systems preferred

· Familiarity with state, local, and federal healthcare programs strongly preferred

· Strong computer and documentation skills required

This role is ideal for an experienced RN seeking a non-bedside, care management-focused position with predictable hours, strong compensation, and the opportunity to make a meaningful impact on patient outcomes and system efficiency.

Full-time

· Health insurance

· Dental insurance

· Vision insurance

· Paid time off

· Retirement plan

Work Location: In person

Contact me directly for more information:
Daniel Trowbridge Medical Solutions Direct Hire C/T:

At Medical Solutions, we’re people who care, helping people who care. No matter how you look at it, there’s a whole lot of care going on in our world and that’s just the way we like it. What do we do? Medical Solutions is one of the nation’s largest providers of total workforce solutions in the healthcare industry, connecting…