Top 7021 Rn Utilization Management Jobs

RN Utilization Management
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
- Vision insurance
Utilization Management Nurse I, RN
Clever Care Health Plan —Huntington Beach, CA
- $34.98 - $42.85 an hour
- Full-time
- Remote
- Background check
- Spanish
- RN License
Utilization Review RN
Houston Methodist Cypress Hospital —Cypress, TX
- Full-time
- Nursing
- RN License
- Hospital
Travel RN-Utilization Review Specialist-Day/Nights-36 Hours-Duluth, GA-$3,085.00
Prolink —Duluth, GA
- $3,085 a week
- Night shift
- Background check
- Vital signs
- RN License
- Health insurance
- Dental insurance
Quick Apply
3d
Utilization Management Registered Nurse RN
Trinity Health Of New England —Hartford, CT
- Full-time
- Hybrid work
- Nursing
- RN License
- Bachelor of Science
Quick Apply
8d
Concurrent Utilization Review Nurse, RN
NeueHealth —Los Angeles, CA
- $74,286.15 - $111,429.23 a year
- Remote
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Utilization Management Nurse
Blue Eagle Consulting —Remote
- RN License
- Mid-level
- Nursing
Quick Apply
Remote Home Health RN – Medical Claims Reviewer
Broadway Ventures —Remote
- $60,000 - $63,000 a year
- Full-time
- Remote
- Nursing
- RN License
- Customer service
Quick Apply
RN - Utilization Management - MGH
The General Hospital Corporation —Boston, MA
- $41.72 - $105.65 an hour
- Part-time
- Remote
- RN License
- Mid-level
- Experience equivalent to degree accepted
- Opportunities for advancement
Quick Apply
5d
Utilization Management Registered Nurse
Humana —South Carolina
- $71,100 - $97,800 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
Denials & Appeals Administrator (RN)
Boston Medical Center —Remote
- $43.03 - $62.50 an hour
- Full-time
- Remote
- Nursing
- RN License
- 5 years
- Health insurance
- Dental insurance
13d
Utilization Review RN
Providence —Mission Hills, CA
- $57.28 - $88.92 an hour
- Per diem
- Hybrid work
- Nursing
- RN License
- Medical office experience
- Paid parental leave
- Paid holidays
Nurse Educator (RN)
Wake Robin Corporation —Shelburne, VT
- $36.70 - $44.77 an hour
- Weekends as needed
- Nursing
- RN License
- Mid-level
- 403(b) matching
- Disability insurance
Quick Apply
Program Director - Registered Nurse
Confidential —Carmel Hamlet, NY
- $100,000 - $107,000 a year
- Full-time
- CPR Certification
- Nursing
- Microsoft Excel
- Health insurance
- Dental insurance
Quick Apply
MDS Coordinator, RN
Confidential —Spartanburg, SC
- Full-time
- Background check
- Anatomy knowledge
- Skilled nursing facility
- Free parking
- Disability insurance
Quick Apply
RN GRADUATE
Covenant HealthCare —Saginaw, MI
- Full-time
- Nursing
- Microsoft Outlook
- Hospital
OBSERVATION UNIT RN
Covenant HealthCare —Saginaw, MI
- Part-time
- Nursing
- Microsoft Outlook
- RN License
TOP Case Management Program Manager
International SOS —San Antonio, TX
- Background check
- Nursing
- RN License
Quick Apply
MEDICAL RENAL RN (H 6 MAIN)
Covenant HealthCare —Saginaw, MI
- Full-time
- Nursing
- RN License
- Hospital
PROGRESSIVE CARDIAC CARE (C 3 MAIN 3 NORTH RN)
Covenant HealthCare —Saginaw, MI
- Full-time
- Acute care
- Nursing
- Microsoft Outlook

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RN Utilization Management

MedStar Health -
Washington, DC

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Job Details

Full-time
$89,065 - $162,801 a year

Benefits

Vision insurance

Qualifications

RN License
Utilization management

Full Job Description

About this Job:

General Summary of Position
The RN Utilization Manager will have 1-2 years of Utilization review- responsible for evaluating the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Responsible for clinical review of acute care services based on Medically Necessity criteria the management of quality health care resources for achievement of desired outcomes and coordination of alternative levels of care in a timely and in the most cost-effective manner.We recruit retain and advance associates with diverse backgrounds skills and talents equitably at all levels.

Primary Duties and Responsibilities

Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
Acts as a liaison to MedStar Family Choice (MFC) contracted vendors to facilitate care. Identifies gaps in contracted services and develops a plan to access care.
Acts as an advocate while assisting members to coordinate and gain access to medical psychiatric psychosocial and other essential services to meet their healthcare needs. Authorizes and monitors covered services according to policy.
Attends and participates in MFC staff meetings Clinical Operations department meetings Special Needs Forums work groups etc. as assigned. Provides input completes assignments and shares new findings with other staff. Participates in meetings and on committees and represents the department and MFC in community outreach efforts. Participates in multi-disciplinary quality and service improvement teams.
Demonstrates behavior consistent with MedStar Health mission vision goals objectives and patient care philosophy.
Demonstrates skill and flexibility in providing coverage for other staff.
Identifies inpatients requiring additional services and initiates care with appropriate providers. Demonstrates emphasis on quality patient care during the pre-admission and/or concurrent review process. Authorizes services according to MedStar Family Choice policy.
Initiates contact with providers to obtain clinical information to facilitate approval or pending of pre-authorization requests inpatient stays and retrospective reviews.
Maintains current knowledge of MFC benefits and enrollment issues in order to accurately coordinate services.
Maintains timely and accurate documentation in the clinical software system per Clinical Operations department's policy.
Monitors utilization of all services for fraud and abuse.
Performs pre-authorization and pharmacy reviews and documents in PBMÆs system when assigned.
Performs telephonic ACD line coverage for Clinical Operations' needs.
Performs telephonic inpatient utilization review services; on-site review as indicated. Process includes: assessment planning coordinating and implementation. Monitors for timely provision of services. Assists hospital case management staff with discharge planning as applicable.
Makes referrals to Case Management as needed.
Sends thorough reviews to Medical Director as appropriate. Coordinates timely review decisions and notifications per policy NCQA standards/guidelines and District of Columbia Contract.
Utilizes evidence-based standards in making coverage determinations in individual patient cases; Identifies and reports potential coordination of benefits subrogation third party liability worker's compensation cases etc. Identifies quality risk or utilization issues to appropriate MedStar personnel.

Minimal Qualifications
Education

Valid RN license in the District of Columbia; or Maryland required and
Bachelor's degree preferred

Experience

1-2 years Recent utilization experience required and
1-2 years Diverse clinical experience required

Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the District of Columbia; or Maryland Upon Hire required and
CCM - Certified Case Manager CCM (Certified Case Manager) Upon Hire preferred

Knowledge Skills and Abilities

Proficient computer skills to enter and retrieve data.
Ability to create edit and analyze Microsoft office (Word Excel and PowerPoint) preferred.
Knowledge of InterQual guidelines preferred.

This position has a hiring range of : USD $89,065.00 - USD $162,801.00 /Yr.

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Refine Your Search

Rn Utilization Management jobs

RN Utilization Management

Utilization Management Nurse I, RN

Utilization Review RN

Travel RN-Utilization Review Specialist-Day/Nights-36 Hours-Duluth, GA-$3,085.00

Utilization Management Registered Nurse RN

Concurrent Utilization Review Nurse, RN

Utilization Management Nurse

Remote Home Health RN – Medical Claims Reviewer

RN - Utilization Management - MGH

Utilization Management Registered Nurse

Denials & Appeals Administrator (RN)

Utilization Review RN

Nurse Educator (RN)

Program Director - Registered Nurse

MDS Coordinator, RN

RN GRADUATE

OBSERVATION UNIT RN

TOP Case Management Program Manager

MEDICAL RENAL RN (H 6 MAIN)

PROGRESSIVE CARDIAC CARE (C 3 MAIN 3 NORTH RN)

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