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Utilization Review Nurse, PRN – Evening Shift
Brundage Group. Conduct hospital admission reviews to determine medical necessity and appropriate patient status (inpatient, observation, outpatient) .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive acute care nursing expertise with a focus on utilization review, applying evidence-based criteria and ensuring compliance with regulatory requirements. Strong communication and collaboration skills are essential for effectively engaging with physicians and case management teams.
Highest-signal resume keywords
Acute Care Nursing ExperienceUtilization Review ExpertiseRegistered Nurse (RN) LicenseElectronic Health Records ProficiencyClinical Documentation Evaluation
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Utilization ReviewClinical Documentation EvaluationEvidence-Based Criteria ApplicationAcute Admission ReviewsContinued Stay Reviews
Soft Skills
Strong Communication SkillsAdaptabilityIndependent Work
Tools & Technologies
Electronic Health RecordsCase Management Systems
Certifications & Qualifications
Registered Nurse (RN) License
Industry Keywords
Medical NecessityPayer ComplianceRegulatory RequirementsInterQualMCG
About the role
Key responsibilities & impact- Conduct hospital admission reviews to determine medical necessity and appropriate patient status (inpatient, observation, outpatient)
- Conduct continued stay reviews using approved clinical criteria and guidelines
- Evaluate clinical documentation for accuracy, completeness, and compliance with payer and regulatory requirements
- Apply evidence-based criteria such as InterQual® and/or MCG®
- Communicate review findings and recommendations to physicians, case management staff, and leadership
- Collaborate with Physician Advisors regarding complex cases or cases not supported by criteria
- Assist with denial prevention activities and accurate documentation
- Perform other duties as assigned
Requirements
What you’ll need- Extensive acute care nursing experience and demonstrated expertise in utilization review within a hospital setting
- Proficient in multiple Electronic Health Records and case management systems
- Strong communication skills; communicates clearly and concisely, verbally and in writing
- Ability to thrive in a fast-paced environment and adapt to frequent changing business needs
- Ability to work independently, needing minimal supervision
- Graduate of an accredited school of nursing
- Current, unrestricted Registered Nurse (RN) license
- Minimum five (5) years of acute care nursing experience in a hospital setting
- Minimum two (2) years of recent hospital-based or health plan utilization review experience
- Experience with acute admission reviews and continued stay reviews
- PRN position requiring a minimum of forty (40) hours per month when hours are available
- At least sixteen (16) required monthly hours must be worked on weekend shifts
- Must work two of the six organization-recognized holidays each calendar year
- Must maintain flexibility and communicate availability according to department scheduling practices
- Must report to work as scheduled and follow attendance and call-off policies
Benefits
Comp & perks- PRN scheduling with shift options of four or eight hours
- Additional hours may be scheduled based on departmental needs and employee availability