Utilization Review Nurse

Utilization Review Nurse – Inpatient

Bakersfield, CA

United Staffing Associates is recruiting an experienced Utilization Review Nurse for a temp-to-hire opportunity with an organization in the healthcare industry. This position is well suited for a Registered Nurse (RN) with experience evaluating the medical necessity and appropriateness of inpatient care, including making initial clinical approval determinations. The role involves collaborating with healthcare providers, patients, caregivers, and other professionals to support care coordination, appropriate use of healthcare resources, and positive patient outcomes.

Key Responsibilities:

• Evaluate the medical necessity and appropriateness of inpatient services through initial, ongoing, and follow-up clinical reviews.
• Assess clinical information against established guidelines to make initial authorization decisions and identify cases requiring additional review.
• Collaborate with healthcare providers and case management teams to support discharge planning and continuity of care.
• Identify individuals who may benefit from care management, disease management, or social services and facilitate appropriate referrals.
• Interpret healthcare benefits and assist with coordinating medically necessary services, including those outside standard coverage.
• Recognize and escalate concerns involving quality of care, insurance benefits, or third-party liability.
• Maintain accurate and timely clinical documentation, patient status information, and authorization records.
• Communicate with patients, caregivers, healthcare providers, and internal teams to coordinate services and address care-related needs.
• Assist with training and supporting new team members.

Qualifications & Experience:

• Active, unrestricted Registered Nurse (RN) license and an associate's degree in Nursing; a bachelor's degree in Nursing, Health Administration, or a related healthcare field is preferred.
• Minimum of two years of full-time clinical nursing experience in acute care, community health, public health, or chronic disease management.
• Experience providing patient and caregiver education related to health conditions and ongoing care.
• Understanding of managed care operations, utilization management requirements, and applicable healthcare regulations.
• Strong clinical knowledge of medical conditions, treatment practices, hospital operations, and healthcare delivery systems.
• Ability to evaluate medical records, interpret clinical information, and apply sound judgment when assessing medical necessity.
• Strong communication, critical thinking, and organizational skills, with the ability to work independently and manage competing priorities.
• Working knowledge of Microsoft Office, electronic databases, and clinical documentation systems.
• Preferred experience or knowledge in care coordination, case management, clinical review guidelines, healthcare coding, quality improvement, or community-based support resources.

Compensation:

$47.00/hour

About United Staffing Associates

United Staffing Associates is a professional search and staffing firm partnering with organizations to identify talented professionals for critical roles. We have been engaged by our client to recruit for this temp-to-hire opportunity and will facilitate the hiring process from initial consideration through placement and potential transition to the client’s team. The identity of the hiring company will remain confidential during the initial stages of the recruitment process.