Utilization Review Nurses
District of Columbia, DC | Healthcare
We are recruiting 5 Full-Time long term contract RNs to perform Utilization Review for DC residents in on-site nursing homes. The RNs will be doing the following:
- Assesses the medical necessity and quality of inpatient admissions, outpatient services, surgical and diagnostic procedures, and other covered services by conducting pre-certification, concurrent, and retrospective reviews
- Applies clinical review criteria, guidelines, and screens in determining the medical necessity of health care services
- Consults with physician/practitioner consultants when reviews fail clinical review criteria, guidelines, and screens
- Refers cases to other professionals internally, as well as to customers and other appropriate external sources when indicated
- Meets performance expectations on quality metrics
- Meets performance expectations on quantity metrics
- As appropriate, provides daily oversight and monitoring of non-clinical staff during their performance of non-clinical support activities; also provides the supervisor with input regarding employees’ performance of these activities.
These are Full-Time 40 hours per week positions. Our Client will provide all RNs with a company laptop. Dependable transportation is required. Mileage reimbursement is available after 1st patient visit each day. (Weekly reports are required to be submitted by RNs) RNs MUST have a current DC License. The contract hourly pay rate is $37.71 and NO overtime will be required.
All candidates must be computer savvy with advanced Word, Excel, and Outlook along with experience emailing & texting from a Smartphone. Qualified applicants will be REQUIRED to complete online assessments in the above software prior to an initial interview.
We are only reviewing candidates with a MINIMUM of 3 years of Chart Review/Utilization Review experience, preferably in an Acute Care Hospital and/or Skilled Nursing Facility. In addition, all RNs must have a valid (or renewable) DC License. Paid Training/Orientation will take place in DC at a Metro accessible location. We are hiring immediately, please submit your resume for immediate and confidential review.
Please forward this email to any of your colleagues who are qualified and/or interested in this project.
DC License; Chart Review/Utilization Review experience; Experience in Acute Care and/or Skilled Nursing Facility; Proficient in MS Word, Excel and Outlook
Please submit resume to firstname.lastname@example.org
NRI is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, among other things, or status as a qualified individual with disability.