RN Utilization Review - Long Term Contract DC

Washington D.C.
Apr 10, 2018
Apr 24, 2018
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
  • 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.

NO overtime will be required.

  • BSN
  • 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

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