Utilization Review Nurse (U/R Nurse)
We are recruiting Full-Time long term contract RNs to perform Utilization Review for DC residents in on-site nursing homes. The RNs will be doing the following:
- Assesses the medical necessity and quality of inpatient admissions, outpatient services, surgical and diagnostic procedures, and other covered services by conducting pre-certification, concurrent, and retrospective reviews
- Applies clinical review criteria, guidelines, and screens in determining the medical necessity of health care services
- Consults with physician/practitioner consultants when reviews fail clinical review criteria, guidelines, and screens
- Refers cases to other professionals internally, as well as to customers and other appropriate external sources when indicated
- Meets performance expectations on quality metrics
- Meets performance expectations on quantity metrics
- As appropriate, provides daily oversight and monitoring of non-clinical staff during their performance of non-clinical support activities; also provides the supervisor with input regarding employees’ performance of these activities.
These are Full-Time 40 hours per week positions. Our Client will provide all RNs with a company laptop. Dependable transportation is required. Mileage reimbursement is available after 1st patient visit each day. (Weekly reports are required to be submitted by RNs) RNs MUST have a current DC License. The contract hourly pay rate is $37.71 and NO overtime will be required.
All candidates must be computer savvy with intermediate Word, Excel, and Outlook along with experience emailing & texting from a Smartphone. Qualified applicants will be REQUIRED to complete online assessments in the above software prior to an initial interview.
We are only reviewing candidates with a MINIMUM of 3 years of Chart Review/ Utilization Review experience, preferably in an Acute Care Hospital and/or Skilled Nursing Facility. In addition, all RNs must have a valid (or renewable) DC License. Paid Training/Orientation will take place in DC at a Metro accessible location. We are hiring immediately, please submit your resume for immediate and confidential review.
Please email you resume to firstname.lastname@example.org