Utilization Review Lead

1 month ago


Anacortes, Washington, United States EliteCare Medical Staffing Full time
Job Title: Utilization Review Lead - RN

EliteCare Medical Staffing is seeking a highly skilled and experienced Utilization Review Lead - RN to join our team. As a key member of our Care Management Department, you will be responsible for overseeing, planning, directing, and coordinating Utilization Review services.

Key Responsibilities:
  • Provide leadership and guidance to other Utilization Review RNs and Social Workers.
  • Lead multidisciplinary rounds to ensure safe discharge plans.
  • Review medical records to determine and document medical necessity for inpatient and observation status.
  • Identify issues and variations in utilization and escalate concerns to appropriate healthcare team members.
  • Develop and coordinate discharge plans in collaboration with the healthcare team.
  • Advocate for necessary services and funding to meet care plan goals.
  • Arrange appropriate community services while adhering to state and federal health regulations.
Requirements:
  • Current Registered Nurse (RN) license in the state of Washington.
  • Bachelor's degree in Nursing preferred; equivalent experience may be considered.
  • Minimum of [insert years] years of experience in Utilization Review or related field.
  • Strong understanding of CMS regulations and compliance standards.
  • Excellent communication, leadership, and interpersonal skills.
Benefits:
  • Competitive salary based on experience.
  • Comprehensive benefits package including health insurance, retirement plans, and paid time off.

At EliteCare Medical Staffing, we value passion for providing high-quality care. We offer a supportive environment where you can grow professionally. If you are ready to make a difference in patients' lives and advance your career, we encourage you to apply.


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