RN Utilization Review - Patient & Family Services - Per Diem

Location: On-site in Nashua, New Hampshire, United States

Company

Healthcare organization providing coordinated patient and family care from admission through discharge.

What you will do

• Assess acute medical necessity using appropriate utilization review criteria.
• Evaluate medical acuity, level-of-care orders, and supporting documentation.
• Work with the care team to facilitate insurance coverage and proactively prevent denials.
• Collect and trend utilization review data metrics.
• Review appeal options for commercial insurance, RAC, and QIO medical necessity denials.
• Apply CMS regulations and commercial insurance guidelines to ensure compliant level-of-care charges.

Requirements

• Current New Hampshire nursing license as a Registered Nurse required.
• Associate of Science in Nursing accepted; BSN required within 10 years of hire.
• Minimum of five years of Registered Nurse experience.
• Experience with InterQual, Milliman, or other acute-care criteria preferred.
• Availability for on-site per diem weekend and holiday shifts required; other days may be available depending on staff availability.

Culture & Benefits

• Health, dental, prescription, and vision coverage is available to full-time and part-time employees.
• Short-term and long-term disability, life, and pet insurance.
• Student loan forgiveness and discounts.
• 403(b) retirement savings plan.
• Continuous earned-time accrual.