Nursing Utilization Review Specialist
1 week ago
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' medical records to ensure accurate and timely reimbursement. This includes analyzing medical documentation, identifying potential denials, and communicating with third-party payors to resolve issues efficiently.
Key Responsibilities:
- Conducts admission, concurrent, and retrospective case reviews to identify areas for improvement and ensure compliance with nationally approved guidelines
- Collaborates with medical staff, physician advisors, social workers, and other ancillary hospital disciplines to meet patients' healthcare needs in a cost-effective manner
- Reviews patients' medical records, documents pertinent information, and communicates with third-party payors to ensure proper reimbursement and minimize unnecessary denials
- Identifies potential risks related to patient care and communicates with appropriate hospital departments to address these concerns
- Serves as a resource to the healthcare team by educating them on utilization management best practices through in-services, staff meetings, and formal educational settings
- Maintains current knowledge of State and Federal regulatory requirements related to utilization review
Requirements:
- Associate's degree in Nursing (Bachelor's degree preferred)
- 3-4 years of experience in an acute care setting (2 years in case management, insurance, or utilization review preferred)
- RN - Registered Nurse - State Licensure and/or Compact State Licensure in the District of Columbia required
- CCM - Certified Case Manager certification is desirable
Skills and Qualifications:
- Excellent problem-solving skills and ability to exercise independent judgment
- Business acumen and leadership skills
- Strong verbal and written communication skills
- Working knowledge of computer software applications
Compensation: The salary range for this position is $87,318 - $157,289 per annum.
-
Medstar Utilization Review Specialist
5 days ago
Washington, Washington, D.C., United States Medstar Full timeJob 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.
-
Utilization Review Nurse
2 days ago
Washington, United States Medix Full timeUtilization 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...
-
Utilization Review Nurse
6 days ago
Washington, United States Medix Full timeUtilization 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...
-
Utilization Review Nurse
2 weeks ago
Washington, United States Medix Full timeUtilization Review Nurse Are you a LPN or an RN with Utilization Review experience? We are hiring for a Utilization Review Nurse in Washington, D.C! This is a great opportuntiy to work with a leading healthcare organization in the DMV! Details are outlined below, interviews are actively going on, apply today!! Overview Day to day Health plan experience...
-
Healthcare Travel Nurse
6 days ago
Washington, United States Medical Solutions Full timeAbout 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...
-
Healthcare Utilization Review Specialist
7 days ago
Washington, United States Medix™ Full timeAbout 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...
-
RN Utilization Review
4 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.\r Education Associate's degree in Nursing required Bachelor's...
-
Utilization Review RN
2 weeks ago
Washington, United States Norman Regional Health System Full timeOverview: 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 timeOverview: 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 timeOverview: 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 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...
-
Registered Nurse
3 weeks ago
Washington, United States MEDSTAR HEALTH 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...
-
Utilization Review RN
2 weeks ago
Washington, OK, United States Norman Regional Health System Full timeOverview: 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...
-
Registered Nurse
3 weeks ago
Washington, United States MEDSTAR HEALTH 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...
-
Registered Nurse
3 weeks ago
Washington, United States MEDSTAR HEALTH 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...
-
Utilization Review Nurse
1 week ago
Washington, United States Medix Full timeOverview 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 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...
-
Clinical Review Specialist
2 weeks ago
Washington, United States Healthcare Legal Solutions LLC Part timeJob DescriptionJob DescriptionDescriptionThe Clinical Review Specialist is responsible for proper clinical review and interpretation of medical records and claim documentation to assist with the appeals of denied insurance claims. Responsibilities include drafting appeal letters based on clinical judgment and knowledge. This is a remote position with the...
-
RN Utilization Review
3 months 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...
-
Registered Nurse
3 weeks ago
Washington DC, United States MEDSTAR HEALTH 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 ...