rn utilization review analyst.

Randstad is seeking a BSN and utlization-review experienced candidate to safeguard reimbursement by researching and resolving Medicaid and commercial payor authorization/denial issues, driving timely appeals, and surfacing denial trends that inform process improvements across Access, Clinics, Managed Care, Business Ops, Leadership, and Legal.

• Mission-driven organization serving the pediatric community.
• Competitive compensation and full benefits package including health, dental, vision, paid time off, and 401(k) match.
• Collaborative and supportive work environment focused on quality and care continuity.

salary: $100,000 - $130,000 per year
shift: First
work hours: 9 AM - 5:30 PM
education: Bachelors

Responsibilities

• Review and resolve authorization/denial cases; set clear direction for next steps.
• Draft timely appeals using standardized criteria (InterQual, MCG) and escalate as needed.
• Monitor patient payor responses to ensure prompt payment/write-off resolution.
• Serve as SME to CRM/Revenue Cycle on authorizations, denials, and appeals.
• Track, trend, and analyze authorization/denial data by payor; deliver weekly/monthly/quarterly/yearly reports.
• Recommend process fixes that reduce future denials.
• Present insights in payor meetings; collaborate with internal teams to optimize reimbursement.
• Educate clinical and non-clinical staff on auth/denial patterns and best practices.

Skills

Utilization Review (3 years of experience is required)

Appeal writing

Insurance Claim Processing

Revenue Cycle (3 years of experience is required)

case management (3 years of experience is preferred)

revenue trend analysis

Qualifications

Years of experience: 3 years

Experience level: Experienced

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.