RN - Utilization Review Contract
- 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
- 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.
- 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