Utilization Review Nurse

Medovent Solutions is a nationally recognized healthcare staffing and consulting firm headquartered in Tampa Bay. We are proud to be named one of the Best Places to Work by the Tampa Bay Business Journal, included in the Fast 50 for fastest-growing companies in Tampa Bay, and honored as part of the prestigious Inc. 5000 list of America’s fastest-growing private companies. We are passionate about supporting healthcare organizations and professionals nationwide with expertise, innovation, and integrity. Utilization Review Nurse Opportunity Overview Location: Southeast United StatesWork Setting: Remote and onsite opportunities availableJob Type: Contract, travel, local, or remote, depending on the assignment Position Summary Medovent Solutions is seeking experienced Utilization Review Nurses for opportunities with leading healthcare organizations throughout the Southeast. These positions are ideal for experienced Utilization Review and Case Management professionals who want to use their clinical expertise to support appropriate patient care, medical necessity, and efficient healthcare delivery. Opportunities may be available in remote, onsite, local, or travel settings based on individual assignment requirements. The successful candidate will be an experienced Registered Nurse who can independently review complex clinical information while collaborating effectively with physicians, case managers, and multidisciplinary healthcare teams. Key Responsibilities Perform prospective, concurrent, and retrospective utilization reviews as required by the assignment.Review clinical documentation to determine medical necessity and the appropriate level of care.Apply MCG and other established clinical criteria consistently and accurately.Evaluate admission, continued-stay, and level-of-care documentation.Identify potential authorization, medical necessity, and utilization concerns.Collaborate with physicians, physician advisors, case managers, clinical teams, and other healthcare professionals.Escalate cases requiring additional review or intervention through the appropriate channels.Maintain complete, accurate, and timely documentation within Epic and applicable utilization management systems.Support compliance with organizational policies, payer requirements, and applicable federal and state regulations.Meet established expectations for review quality, productivity, accuracy, and timely case completion.Protect patient confidentiality and comply with all applicable privacy requirements.Adapt to the workflows, policies, and operational needs of each assigned healthcare environment. Required Qualifications Current, unrestricted Registered Nurse license.Previous professional experience in Utilization Review and Case Management.Experience using Epic.Experience applying MCG or comparable utilization review criteria.Strong knowledge of medical necessity, level-of-care determination, and utilization management practices.Ability to interpret complex medical records, clinical findings, treatment plans, and supporting documentation.Strong clinical judgment, critical-thinking, organizational, and communication skills.Ability to work independently while collaborating effectively with multidisciplinary teams.Ability to meet the remote, onsite, local, or travel requirements of the applicable assignment. Preferred Qualifications Experience performing prospective, concurrent, and retrospective utilization reviews.Experience supporting hospital-based Utilization Review or Case Management operations.Experience with travel Case Management or short-term healthcare assignments.Experience working across multiple healthcare environments and utilization management workflows. Why Join Medovent Solutions? Medovent Solutions connects experienced healthcare professionals with meaningful opportunities that align with their clinical expertise and career goals. If you are an experienced Registered Nurse with a background in Utilization Review or Case Management, we encourage you to apply and explore current opportunities throughout the Southeast. Medovent Solutions offers an exceptional benefits package including a comprehensive medical/dental/vision plan, a 401(k) savings plan, paid holidays, and vacation pay. Medovent Solutions is an Equal Opportunity Employer and does not discriminate in its employment practices on the basis of race, religion, sex, color, national origin, age, disability, citizenship, genetic information, veteran status or military service, or any other characteristic protected by federal or Florida law.