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This role is responsible for performing quality and utilization management reviews to determine residents continued need for services and appropriate acuity levels. The RN will partner with provider organizations to ensure regulatory compliance and support high-quality, cost-effective care delivery.

Responsibilities

• Conduct quality and utilization management reviews for continued stay evaluations
• Perform onsite reviews at senior living and long-term care facilities in Washington, DC and Maryland
• Ensure documentation and care plans meet regulatory standards, including PASRR, MDS, Medicare, Medicaid, and other applicable guidelines
• Collaborate with interdisciplinary teams and external partners
• Manage multiple priorities while maintaining strong attention to detail

Shift: Monday - Friday 8:30a-5p

Qualifications

• Current, active, unrestricted RN license in Washington, DC OR Licensed Independent Clinical Social Worker (LICSW) credential
• 2+ years of admission screening and care planning experience in Long-Term Care
• 1+ year of MDS or continued stay utilization review experience
• Minimum 2+ years of direct clinical (patient care) experience
• Degree or diploma in Nursing or Social Work
• Works independently and demonstrates strong critical thinking skills
• Thinks creatively and “outside the box” to identify solutions
• Quickly adapts to new reports, systems, and processes
• Highly organized and comfortable managing multiple concurrent tasks
• Strong background in Quality Improvement and Utilization Management best practices
• Experience with Medicare and Medicaid evaluation criteria
• Expertise in PASRR, MDS, and continued stay evaluations
• Familiarity with at least one medical management application (Jiva preferred)
• Reliable transportation for onsite visits

For immediate consideration, send your resume to mmercer@nri-staffing.com