Registered Nurse - Utilization Review Contract
Looking for an experienced Utilization Review RN to perform reviews for DC residents in skilled nursing facilities. 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
- 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. (Weekly reports are required to be submitted by RNs)
NO overtime will be required.
- Valid Unencumbered DC RN License
- Reliable transportation
- Proficient using Word, Excel, and Outlook
- Comfortable emailing & texting from a Smartphone/iPhone
- All applicants will need to complete online software assessments
- 3 years’ Utilization Review experience
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.