Registered Nurse - Utilization Review Contract

Employer
NRI
Location
Washington D.C.
Posted
Aug 29, 2017
Closes
Sep 15, 2017
Function
Nurse
Industry
Healthcare
Hours
Full Time
Looking for 2 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
  • Valid Unencumbered DC RN License
  • Reliable transportation
  • Proficient using Word, Excel, and Outlook
  • Comfortable emailing & texting from a Smartphone/iPhone
  • All applicants will need to complete online software assessments
  • 3 years’ Utilization Review experience