Utilization Review RN
Washington, DC | Healthcare
We are searching fro Full-Time, long term contract Registered Nurses 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.
Our Client will provide all RNs with a company laptop. Mileage reimbursement is available after 1st patient visit each day. Dependable transportation is required. RNs MUST have a current DC License. Paid Training/Orientation will take place in DC at a Metro accessible location. We are hiring immediately, please submit your resume to firstname.lastname@example.org for immediate and confidential review.
1. MINIMUM of 3 years of Utilization Review/ Chart Review experience, preferably in an Acute Care Hospital and/or Skilled Nursing Facility.
2. Valid (or renewable) DC License
3. Strong Microsoft Word and Excel skills
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.