Travel Nurse RN - Utilization Review - $1,688 per week

About the role

Care Management Coordinator/ RN (Utilization Review) – Travel position. Specialty: Utilization Review; Discipline: RN. Remote role; candidates must reside in NJ, PA, or DE. Start date: 10/26/2026. Duration: 13 weeks. 37.5 hours per week, 8‑hour day shifts. Employment type: Travel. Two openings available.

Responsibilities

• Perform utilization management for inpatient admissions either onsite or telephonically.
• Using medical software criteria, establish the need for inpatient, continued stay and length of stay.
• Direct the delivery of care to the most appropriate setting while maintaining quality.
• Contact attending physicians regarding treatment plans/plan of care and clarify medical need for inpatient stay or continued inpatient care.
• Identify inpatient admissions no longer meeting criteria and refer care to plan Medical Directors for evaluation.
• Present cases to Medical Directors that do not meet established criteria and provide pertinent information regarding members' medical condition and potential home care needs.
• Perform early identification of hospitalized members to evaluate discharge planning needs.
• Collaborate with hospital case management staff, physician and family to determine alternative settings and provide support to facilitate discharge to the most appropriate setting.
• Identify and refer cases for case management and disease management.
• Identify quality of care issues including delays in care; appropriately refer cases to the Quality Management Department and/or Care Management and Coordination Supervisor when indicated.
• Maintain system information integrity by timely, accurate data entry.
• Ensure utilization decisions comply with state, federal and accreditation regulations.
• Build relations with all providers and provide exceptional customer service.
• Report potential utilization issues or trends to designated supervisor and recommend improvements.
• Participate in educating providers on managed care.
• Perform additional related duties as assigned.

Requirements

Candidates must have UM experience either in an outpatient setting (PT/OT) or an inpatient setting in bariatric or any surgical elective procedures (two submissions needed). Must have outpatient experience, chemotherapy, office or infusion center; prior authorization experience is preferred (one submission needed).

Schedule

37.5 hours per week; 8‑hour day shifts.