Utilization Review Nurse

5 days ago


Washington, United States Medix Full time
Utilization Review Nurse

Are you a LPN or an RN licensed in Washington, D.C. with Utilization Review experience? We are hiring for a Fully Remote Utilization Review Nurse to work with a leading healthcare organization in the DMV Details are outlined below, interviews are actively going on, apply today

Overview

Ensure that patients receive the right care at the right time while also controlling healthcare costs and maintaining quality standards. Review patient records, treatment plans, and procedures to determine if the care being provided is medically necessary and aligned with established guidelines. Work closely with doctors, nurses, and other healthcare professionals to discuss care plans, suggest alternatives, and help coordinate care to prevent unnecessary treatments or hospital stays.
  • Day to day
    • Health plan experience
    • Hospital experience
    • Interqual is preferred. Miliman works as well.
    • Experience in health plans reviews (dermal medicine, home health, rehab)
    • Pediatric inpatient admissions is a plus
    • Authorization, long term care, skilled nursing, behavioral analysis would be a plus.
    • Looking at 15 cases a day.
  • Patient population - case load
    • Pediatrics as well as adults from 18-25
    • Can often see cerebral palsy, genetic issues, cancer, behavioral health (bipolar), substance abuse, will often be UR for Admissions with children's

Required Skills

-RN or LPN with experience

-UR in a health plan/insurance

-Interqual or Miliman experience

Nice to Have Skills

-Self motivated

-Productive

-Communication skills

Schedule

Monday through Friday 8:00AM-5:00PM

Pay Rate: $40.00-$46.00

Medix is acting as an Employment Agency in relation to this vacancy.

  • Washington, United States Medix Full time

    Utilization Review Nurse Are you a LPN or an RN licensed in Washington, D.C. with Utilization Review experience? We are hiring for a Fully Remote Utilization Review Nurse to work with a leading healthcare organization in the DMV! Details are outlined below, interviews are actively going on, apply today!! Overview Ensure that patients receive the right...


  • Washington, United States MedStar Health Full time

    About the Role:We are seeking a skilled Nursing Utilization Review Specialist to join our team at MedStar Health. In this role, you will play a critical part in ensuring high-quality patient care by conducting admission, concurrent, and retrospective case reviews.Job Summary:The Nursing Utilization Review Specialist conducts thorough reviews of patients'...

  • RN Utilization Review

    4 weeks ago


    Washington, United States Medstar Full time

    Conducts admission, concurrent, and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. Collaborates with medical staff and ancillary hospital disciplines to ensure high-quality patient care in the most efficient way.\r Education Associate's degree in Nursing required Bachelor's...

  • Utilization Review RN

    2 weeks ago


    Washington, United States Norman Regional Health System Full time

    Overview: The Utilization Review team is comprised of highly skilled Registered Nurses who ensure Norman Regional Health System follows a compliant review process to determine appropriateness of admission. Responsibilities: Utilization Review, Utilization Management, Advocacy and Education Clinical Analysis and Data Management Clinical Care...


  • Washington, United States Norman Regional Health System Full time

    Overview: The Utilization Review team is comprised of highly skilled Registered Nurses who ensure Norman Regional Health System follows a compliant review process to determine appropriateness of admission. Responsibilities: Utilization Review, Utilization Management, Advocacy and Education Clinical Analysis and Data Management Clinical Care...

  • Utilization Review RN

    2 weeks ago


    Washington, United States Norman Regional Health System Full time

    Overview: The Utilization Review team is comprised of highly skilled Registered Nurses who ensure Norman Regional Health System follows a compliant review process to determine appropriateness of admission. Responsibilities: Utilization Review, Utilization Management, Advocacy and EducationClinical Analysis and Data ManagementClinical Care...

  • Registered Nurse

    3 weeks ago


    Washington, United States MEDSTAR HEALTH Full time

    Conducts admission, concurrent, and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. Collaborates with medical staff and ancillary hospital disciplines to ensure high-quality patient care in the most efficient way.EducationAssociate's degree in Nursing required Bachelor's degree...

  • Registered Nurse

    3 weeks ago


    Washington, United States MEDSTAR HEALTH Full time

    Conducts admission, concurrent, and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. Collaborates with medical staff and ancillary hospital disciplines to ensure high-quality patient care in the most efficient way.EducationAssociate's degree in Nursing required Bachelor's degree...

  • Registered Nurse

    3 weeks ago


    Washington, United States MEDSTAR HEALTH Full time

    Conducts admission, concurrent, and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. Collaborates with medical staff and ancillary hospital disciplines to ensure high-quality patient care in the most efficient way.EducationAssociate's degree in Nursing required Bachelor's degree...

  • Registered Nurse

    3 weeks ago


    Washington, United States MEDSTAR HEALTH Full time

    Conducts admission, concurrent, and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. Collaborates with medical staff and ancillary hospital disciplines to ensure high-quality patient care in the most efficient way.EducationAssociate's degree in Nursing required Bachelor's degree...

  • Utilization Review RN

    2 weeks ago


    Washington, OK, United States Norman Regional Health System Full time

    Overview: The Utilization Review team is comprised of highly skilled Registered Nurses who ensure Norman Regional Health System follows a compliant review process to determine appropriateness of admission. Responsibilities: Utilization Review, Utilization Management, Advocacy and Education Clinical Analysis and Data Management Clinical Care...


  • Washington, United States Medix™ Full time

    About the RoleMedix is seeking a skilled and experienced Utilization Review Nurse to join our team. This role requires strong clinical knowledge, excellent communication skills, and the ability to work independently in a fast-paced environment.Job SummaryWe are looking for a dedicated RN with experience in utilization review, particularly in health plans and...


  • Washington, United States Medix Full time

    Overview of Utilization Review Nurse RoleWe are seeking an experienced Utilization Review Nurse to join our team in Washington, D.C.This is a great opportunity to work with a leading healthcare organization in the DMV, leveraging your expertise in health plan reviews and utilization management.Responsibilities:Conduct daily health plan reviews, ensuring...

  • Registered Nurse

    3 weeks ago


    Washington DC, United States MEDSTAR HEALTH Full time

    Conducts admission, concurrent, and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. Collaborates with medical staff and ancillary hospital disciplines to ensure high-quality patient care in the most efficient way. Education Associate's degree in Nursing required Bachelor's...

  • RN Utilization Review

    3 months ago


    Washington, United States MEDSTAR HEALTH Full time

    General Summary of PositionConducts admission, concurrent, and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. Collaborates with medical staff and ancillary hospital disciplines to ensure high-quality patient care in the most efficient way. Primary Duties and...

  • Registered Nurse

    3 weeks ago


    Washington DC, United States MEDSTAR HEALTH Full time

    Conducts admission, concurrent, and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. Collaborates with medical staff and ancillary hospital disciplines to ensure high-quality patient care in the most efficient way. Education Associate's degree in Nursing required ...

  • Utilization Review RN

    2 weeks ago


    Washington, OK, United States Norman Regional Health System Full time

    Overview: The Utilization Review team is comprised of highly skilled Registered Nurses who ensure Norman Regional Health System follows a compliant review process to determine appropriateness of admission. Responsibilities: Utilization Review, Utilization Management, Advocacy and EducationClinical Analysis and Data ManagementClinical Care...


  • Washington, United States Medical Solutions Full time

    About This OpportunityWe're seeking a skilled Utilization Review specialist to join our team as a Travel Nurse RN in Washington, District of Columbia.This 13-week contract offers a unique opportunity for healthcare professionals to showcase their expertise and dedication while exploring new horizons. As a key member of our team, you'll work closely with...

  • Registered Nurse

    3 weeks ago


    Washington, DC, United States MEDSTAR HEALTH Full time

    Conducts admission, concurrent, and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. Collaborates with medical staff and ancillary hospital disciplines to ensure high-quality patient care in the most efficient way.EducationAssociate's degree in Nursing required Bachelor's degree...


  • Washington, Washington, D.C., United States Medstar Full time

    Job OverviewWe are seeking a highly skilled Utilization Review Specialist to join our team at Medstar. In this role, you will play a crucial part in ensuring high-quality patient care by conducting thorough reviews of medical records.