Utilization Review Registered Nurse (RN)

Horizon Healthcare Staffing is seeking a highly skilled Utilization Review Registered Nurse for a 13-week travel assignment with a leading healthcare system in New Jersey.

This is a professional, non-bedside role ideal for experienced RNs with a strong background in utilization review, denial management, and ED gatekeeping who can step into a fast-paced environment with minimal onboarding.

Assignment Details:

• Dates: January 5, 2026 – April 4, 2026
• Hours: 36 hours/week
• Shift: 12-hour shifts (8:00am–8:30pm or 7:30am–8:00pm)
• Program: Travel Nursing
• Facility: Acute care hospital in Hopewell – Pennington, NJ
• Unit: Central Resource Office

Position Summary

The Utilization Review RN is responsible for conducting concurrent reviews with a strong emphasis on level-of-care determinations, particularly from the Emergency Department (ED gatekeeping) perspective.

This role plays a critical part in ensuring appropriate patient placement, regulatory compliance, and optimal use of hospital resources while collaborating closely with physicians, payers, and interdisciplinary teams.

Key Responsibilities

• Perform concurrent review of patient medical records
• Determine appropriate level of care using established UR criteria (MCG preferred)
• Communicate with payers regarding admissions, continued stays, and denials
• Document utilization activities, barriers to care, and progression of treatment
• Identify opportunities to reduce avoidable days and unnecessary resource use
• Collaborate with physicians, case managers, and care teams
• Maintain compliance with CMS regulations and payer guidelines
• Participate in daily huddles, care team meetings, and performance improvement initiatives

Minimum Requirements

• Education: Associate’s Degree in Nursing (BSN preferred)
• License: Active New Jersey RN license

Experience:

• Minimum 5 years of clinical nursing experience
• 2–3 years of utilization review, denial management, or quality management experience
• Must be able to function independently with minimal training

Skills:

• Strong working knowledge of UR guidelines (MCG preferred)
• Proficiency with EMR systems, UR software, and Microsoft Office
• Excellent communication and problem-solving skills

Preferred Certifications:

• CPHQ
• CCM
• ACM
• CPUR