Job Title: RN – Utilization Review (UR) | Home Health
Location: Atlanta, GA (Onsite – No home visits are required)
Contract: 13 Weeks of contract
Shift: Days | 8:30 AM – 5:00 PM
Pay rate: $70/hr. on W2
Job Description
We are seeking an experienced Utilization Review Registered Nurse (UR RN) to support the Care at Home – Home Health program. This position focuses on reviewing patient cases to ensure appropriate utilization of healthcare services, regulatory compliance, and quality patient outcomes.
Key Responsibilities
Perform utilization review for Home Health patients to ensure appropriate level of care.
Review clinical documentation for medical necessity, insurance authorization, and compliance with regulatory guidelines.
Collaborate with physicians, case managers, and interdisciplinary teams to optimize patient care plans.
Monitor patient progress and recommend appropriate levels of care and service utilization.
Maintain accurate documentation in the electronic medical record.
Ensure compliance with CMS, payer, and organizational policies.
Communicate effectively with internal teams regarding authorization status and care coordination.
Support quality improvement initiatives and utilization management goals.
Requirements
Active Registered Nurse (RN) License.
Previous Utilization Review (UR) experience required.
Home Health and/or Care Management experience preferred.
Strong knowledge of medical necessity criteria, utilization management, and clinical documentation review.