Current jobs related to Utilization Review Nurse - Washington - Medstar
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Utilization Review Nurse
2 months ago
Washington, Washington, D.C., United States MedStar Medical Group Full timeJob Summary:MedStar Medical Group is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring that patients receive the most appropriate and cost-effective care.Key Responsibilities:Conduct thorough admission, concurrent, and retrospective case reviews to identify opportunities for...
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Utilization Review Nurse
3 weeks ago
Washington, Washington, D.C., United States MEDSTAR HEALTH Full timeJob SummaryWe are seeking a skilled Utilization Review Nurse to join our team at MEDSTAR HEALTH. As a key member of our case management team, you will play a critical role in ensuring high-quality patient care while promoting efficient use of healthcare resources.Key ResponsibilitiesConduct thorough admission, concurrent, and retrospective case reviews to...
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Utilization Review Nurse
3 weeks ago
Washington, Washington, D.C., United States Medstar Full timeJob Title: Utilization Review Nurse, Case ManagementMedstar is seeking a skilled Utilization Review Nurse to join our team. As a key member of our case management department, you will play a critical role in ensuring high-quality patient care while optimizing resource utilization.Responsibilities:Conduct admission, concurrent, and retrospective case reviews...
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Utilization Review Nurse
2 days ago
Washington, Washington, D.C., United States Medstar Full timeJob SummaryAs a Utilization Review Nurse at Medstar, you will play a crucial role in ensuring high-quality patient care while maintaining efficiency. Your primary responsibility will be to conduct admission, concurrent, and retrospective case reviews to verify the appropriateness of patient care and level of treatment. You will collaborate with medical staff...
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Nurse Utilization Review Specialist
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Washington, Washington, D.C., United States Medix Full timeJob Summary:Medix is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will be responsible for conducting prospective, concurrent, and retrospective utilization reviews to ensure that members receive necessary care while minimizing costs. This is a 100% remote position, requiring a DC nursing license and 1-2...
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Utilization Review Nurse Specialist
3 weeks ago
Washington, Washington, D.C., United States Medix Full timeJob SummaryMedix is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring that patients receive necessary and effective care while optimizing resource utilization.Key ResponsibilitiesAssessment and Review: Conduct thorough assessments of patient care, review medical records and...
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Utilization Review Nurse Specialist
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Washington, United States Medix Full timeJob Title: Utilization Review NurseWe are seeking a skilled Registered Nurse with experience in Utilization Review to join our team at Medix. As a Utilization Review Nurse, you will play a critical role in ensuring that patient care is effective and efficient.Key Responsibilities:Assess Patient Care: Review medical records and care plans to ensure that...
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Utilization Review Nurse
4 weeks ago
Washington, United States Medix Full timeWe are looking for a Registered Nurse experienced in Utilization Review, looking to work within a diverse population. Some responsibilities include... Assessing patient care, review medical records and care plans to make sure that treatments are necessary and effective. Evaluating how well resources are being used. Deciding on coverage, determining if...
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RN Utilization Review
3 months ago
Washington, United States MedStar Medical Group Full timeGeneral Summary of PositionUnder the direction of The Director of UM/Appeals assists in the administration of utilization functions, the Utilization Review Nurse, assesses patient insurance/status to facilitate appropriate completion of utilization review using payer specific criteria; uses Interqual and MCG to determine medical necessity and appropriateness...
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RN Utilization Review Specialist
3 weeks ago
Washington, Washington, D.C., United States MedStar Medical Group Full timeJob SummaryWe are seeking a skilled RN Utilization Review Specialist to join our team at MedStar Washington Hospital Center. As a key member of our Utilization Review team, you will play a critical role in ensuring that our patients receive the highest quality care in the most efficient and cost-effective manner.Key ResponsibilitiesConduct thorough...
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Clinical Utilization Review Specialist
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Washington, Washington, D.C., United States Medstar Full timeJob SummaryMedstar is seeking a skilled Utilization Review Nurse to join our Case Management team. As a key member of our team, you will conduct admission, concurrent, and retrospective case reviews to ensure appropriate admit status and level of care.You will collaborate with medical staff and ancillary hospital disciplines to provide high-quality patient...
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Utilization Review Nurse, Case Management
3 weeks ago
Washington, United States Medstar Full timeConducts 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...
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Utilization Review Nurse, Case Management
3 weeks ago
Washington, United States Medstar Full timeConducts 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...
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Utilization Review Nurse, Case Management
2 weeks ago
Washington, United States MEDSTAR HEALTH Full timeGeneral 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...
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Utilization Review Nurse
2 weeks ago
Washington, DC, United States MEDSTAR HEALTH Full timeJob SummaryWe are seeking a skilled Utilization Review Nurse to join our team at MedStar Health. As a key member of our case management team, you will play a critical role in ensuring high-quality patient care while promoting efficient use of hospital resources.Key ResponsibilitiesConduct thorough admission, concurrent, and retrospective case reviews to...
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Clinical Review Nurse
2 months ago
Washington, Washington, D.C., United States MedStar Medical Group Full timeOverview of the RoleUnder the supervision of the Director of Utilization Management and Appeals, the Clinical Review Nurse plays a pivotal role in managing utilization processes. This position involves evaluating patient insurance status to ensure the effective execution of utilization reviews in accordance with payer-specific guidelines. The nurse utilizes...
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Medical Nurse Reviewer
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Medical Nurse Reviewer
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Medical Nurse Reviewer
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Utilization Review Nurse
2 months ago
Are you a skilled Utilization Review Nurse seeking a flexible PRN role that includes weekend shifts? MedStar Health Washington Hospital Center is looking for a PRN UR Nurse to provide support as needed, including weekends.
Position Summary
Under the supervision of the Director of Utilization Management and Appeals, the Utilization Review Nurse plays a crucial role in managing utilization processes. This position involves evaluating patient insurance status to ensure effective completion of utilization reviews in accordance with payer-specific guidelines. The nurse will utilize Interqual and MCG criteria to assess medical necessity and the appropriateness of inpatient or observation status. Additionally, this role serves as a vital communication link among registered nurse case managers, social workers, on-site reviewers, patient financial services, outpatient departments, and registration.
Core Responsibilities
1. Conduct admission, concurrent, and retrospective case evaluations to align with hospital objectives aimed at delivering high-quality patient care efficiently.
2. Work towards achieving departmental goals while adhering to organizational policies, procedures, and quality standards. Ensure compliance with regulations established by governmental and accrediting bodies.
3. Collaborate with medical professionals, physician advisors, social workers, and other hospital disciplines to address patients' healthcare needs in a cost-effective manner.
4. Review patients' medical records, document essential information, and communicate with third-party payers promptly to secure appropriate hospital reimbursement and minimize unnecessary denials.
5. Implement strategies to prevent potential denials by engaging with key stakeholders, including attending physicians.
6. If required, prepare non-coverage notifications, ABN, MOON letters, and other relevant documents in accordance with organizational, governmental, and accrediting policies and regulations.
Qualifications
- Associate's degree in nursing is required.
- Bachelor's degree in nursing is preferred.
- A minimum of 3 years of experience in an acute care environment is required.
- At least 2 years of experience in Case Management, Insurance, Utilization Review, or a related field is strongly preferred.
- Active DC Nursing License is necessary.
- CCM Certification is preferred.
