Nurse Manager, Utilization Review
4 days ago
This position will manage activities and staff of the Utilization Review and Clinical Documentation Improvement departments.
- Supervise and evaluate the daily work of these teams in accordance with departmental and organizational policies.
- Provide education within the departments and the organization at large on clinical care, levels of care, and financial issues.
- Analyze and report data related to case management activities, payer activities, resource utilization, and clinical denials.
- Lead hospital wide initiatives on behalf of the department.
- Monitor the performance, collection and analysis of data to report on the effectiveness of process improvement to the organization and department.
- Participate in the planning, development and implementation, and ongoing success of the Clinical Documentation Management Program.
- Educate members of the patient care team regarding documentation guidelines, including attending physicians, nursing, and other interdisciplinary team members.
Minimum Education
- Master's Degree (Required)
Minimum Work Experience
- 7 years Healthcare experience (Required)
- 3 years Supervisory experience (Required)
Required Licenses and Certifications
- Registered Nurse in District of Columbia (Required)Basic Life Support for Healthcare Provider (BLS) (Required)
- CCDS or CDIP (Preferred)
- Case Management Certification (CCM or CMSA) (Preferred)
-
Utilization Review Nurse
4 weeks 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
4 weeks 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
3 weeks ago
Washington, United States Medix Full timeJob Title: Utilization Review RN Location: REMOTE, must be licensed RN in D.C.. Job Description 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,...
-
Utilization Review Case Manager Lead
1 month ago
Washington, United States MedStar Health Full timeJob DescriptionThis is a dynamic opportunity to lead utilization review efforts in an acute care setting.About the RoleAs a Utilization Review Case Manager Lead, you will be responsible for conducting admission, concurrent, and retrospective case reviews to ensure appropriate admit status and level of care. You will collaborate with medical staff and...
-
Utilization Review Nurse
1 month 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...
-
washington, United States Children's National Hospital Full timeThis position will manage activities and staff of the Utilization Review and Clinical Documentation Improvement departments.Supervise and evaluate the daily work of these teams in accordance with departmental and organizational policies. Provide education within the departments and the organization at large on clinical care, levels of care, and financial...
-
washington, United States Children's National Hospital Full timeThis position will manage activities and staff of the Utilization Review and Clinical Documentation Improvement departments.Supervise and evaluate the daily work of these teams in accordance with departmental and organizational policies. Provide education within the departments and the organization at large on clinical care, levels of care, and financial...
-
Healthcare Travel Nurse
4 weeks 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...
-
Medstar Utilization Review Specialist
4 weeks 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.
-
Washington, United States Medical Solutions Full timeWe are seeking a skilled RN with experience in Utilization Review to join our team as a travel nurse.About the RoleSpecialty: Utilization ReviewDuration: 13 weeksShift: 8 hours, daysEmployment Type: TravelThis role is ideal for professionals who enjoy working in a fast-paced environment and have excellent communication skills.ResponsibilitiesProvide...
-
Clinical Utilization Manager
1 month ago
Washington, United States MedStar Health Full timeJob SummaryClinical Utilization Managers play a vital role in ensuring that patients receive the most appropriate level of care while minimizing unnecessary costs. At MedStar Health, we seek a seasoned RN with expertise in utilization review and case management to join our team as a Clinical Utilization Manager.About the RoleIn this critical position, you...
-
Clinical Accreditation Reviewer
6 months ago
Washington, United States URAC Full timeMajor purpose of this job: The Accreditation Reviewer is an expert in the content and interpretation of accreditation programs and standards. Primary responsibilities include analyzing accreditation application documentation and conducting validation reviews. Key additional responsibilities include participating in the standards development/revision process,...
-
Utility Program Manager
1 month ago
Washington, Washington, D.C., United States nTech Workforce Full timeJob SummarynTech Workforce is seeking a results-driven Utility Program Manager to oversee various electric utility distribution programs and projects.The salary for this position is approximately $90,000 per year, commensurate with experience.About the Position:This is a leadership role that requires strategic thinking and problem-solving skills.The ideal...
-
Healthcare Review Professional
1 month ago
Washington, Washington, D.C., United States Healthcare Legal Solutions LLC Full timeJob DescriptionWe are seeking a skilled Clinical Review Specialist to join our team at Healthcare Legal Solutions LLC.Salary: $45+ per hour, with eligibility for monthly bonuses after 90 days of employment and potential benefits including 401k, health insurance, disability insurance, and commuter benefits upon conversion to full-time.Responsibilities:Draft...
-
Healthcare Utilization Specialist
4 weeks ago
Washington, Washington, D.C., United States Prisma Health Full timeJob SummaryThis position provides in-depth analysis and expertise in coding and utilization review for Homecare patients and clinical staff. A key aspect of this role is to identify areas of improvement and optimize resource allocation to ensure accurate reimbursement.Key ResponsibilitiesDevelop and deliver coding education programs for clinical and...
-
HCBS Utilization Management Nurse Specialist
4 weeks ago
Washington, Washington, D.C., United States Optum Full timeAbout Optum">Optum is a leading healthcare company dedicated to improving the lives of millions of people around the world. Our mission is to help people live healthier lives and make the health system work better for everyone.We believe that everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their...
-
Electric Utilities Director
1 week ago
Washington, United States City of Washington Full timeAbout the RoleWe are seeking an experienced and skilled Electric Utilities Director to lead our utility systems division. As a key member of our team, you will be responsible for overseeing the expansion, construction, maintenance, and repair of our municipal-owned electrical utility system.Key ResponsibilitiesCoordinate priorities and objectives on new or...
-
Healthcare Utilization Specialist
2 weeks ago
Washington, United States Elevance Health Full timeJob OverviewElevance Health is a leading healthcare company dedicated to improving lives and communities. As a Utilization Management Nurse, you will play a vital role in ensuring that our members receive high-quality, cost-effective care. This position requires strong clinical knowledge, excellent communication skills, and the ability to work...
-
Clinical Nurse Specialist
2 weeks ago
Washington, United States Elevance Health Full timeAbout the RoleWe are seeking a skilled Clinical Nurse Specialist to join our team in Utilization Management. As a key member of our healthcare optimization team, you will work collaboratively with healthcare providers and members to promote quality member outcomes, optimize benefits, and ensure effective use of resources.
-
Utilization Management Strategist
2 weeks ago
Washington, Washington, D.C., United States Healthcare Recruitment Partners Full timeAbout Our OrganizationHealthcare Recruitment Partners is a leading provider of recruitment services to the healthcare industry. We are seeking an experienced Clinical Operations Manager to join our team.Job DescriptionThe Clinical Operations Manager will be responsible for developing and implementing utilization management strategies that align with our...