Top 8392 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 Registered Nurse RN
Trinity Health Of New England —Hartford, CT
- Full-time
- Hybrid work
- Nursing
- RN License
- Bachelor of Science
Quick Apply
8d
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
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
TOP Case Management Program Manager
International SOS —San Antonio, TX
- Background check
- Nursing
- RN License
Quick Apply
Assistant Director of Nursing (Home Health) – RN or LPN/LVN – $95,000–$115,000/yr FT | Las Cruces
Matrix Home Care Services of New Mexico —Las Cruces, NM
- $95,000 - $115,000 a year
- Full-time
- Background check
- Spanish
- Nursing
- Health insurance
- Paid time off
Quick Apply
6d
Experienced Skilled Home Care RN Clinical Managers
TidalHealth Home Care Maryland —Salisbury, MD
- $85,000 - $100,000 a year
- Full-time
- Background check
- CPR Certification
- Nursing
- Travel reimbursement
- Paid training
Quick Apply
RN Care Manager - Case Management - Shoreline Hospital
CHRISTUS Health —Corpus Christi, TX
- $27.50 - $46.00 an hour
- Full-time
- Acute care
- Background check
- Master of Social Work
- 403(b) matching
- Relocation assistance
Quick Apply
RN Clinical Manager
Patients First Home Care LLC —Bradenton, FL
- $80,000 - $90,000 a year
- Full-time
- Background check
- CPR Certification
- Current TB test
- Continuing education credits
- Paid holidays
Quick Apply
Director of Nursing
Northfield Retirement Community —Scottsbluff, NE
- Overnight shift
- Background check
- CPR Certification
- Nursing
- Health insurance
- Dental insurance
Quick Apply
RN Utilization Management - Nights onsite
CHRISTUS Health (IHE/Hosted) —Corpus Christi, TX
- $31.70 - $47.00 an hour
- Full-time
- Background check
- Master of Social Work
- Nursing
- Health savings account
- Relocation assistance
Quick Apply
Part time Registered Nurse
Riverview Manor —Selah, WA
- $35 - $39 an hour
- Part-time
- Background check
- RN License
- HIPAA
- Flexible schedule
Quick Apply
MDS Coordinator RN - Sequim, WA
Avamere Olympic Rehabilitation of Sequim —Sequim, WA
- $53 - $63 an hour
- Full-time
- Nursing
- Skilled nursing facility
- RN License
- Disability insurance
- Health insurance
Quick Apply
HOME CARE - RN CASE MANAGER
Aultman Health Foundation —Canton, OH
- Weekends as needed
- Nursing
- RN License
- Computer literacy
Patient Care Manager - Floater (RN)
VITAS Healthcare —Lombard, IL
- $0.70 per mile
- Full-time
- Nursing
- RN License
- Mid-level
- Travel reimbursement
- Disability insurance
Quick Apply
RN Unit Manager
Aloha Nursing Rehab Centre —Kaneohe, HI
- From $96,000 a year
- 8 hour shift
- Background check
- CPR Certification
- Nursing
- Free parking
- Paid holidays
Quick Apply
Director of Clinical Services (RN) Home Health
Adaptive Home Health —Las Vegas, NV
- Full-time
- RN License
- Office
- Ability to lift 50 pounds
- Dental insurance
- Paid time off
Quick Apply

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RN Utilization Management

MedStar Health -
Washington, DC

Apply Now

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.

Apply Now

Refine Your Search

Rn Utilization Management jobs

RN Utilization Management

Utilization Management Registered Nurse RN

Utilization Management Registered Nurse RN

Concurrent Utilization Review Nurse, RN

Nurse Educator (RN)

Program Director - Registered Nurse

MDS Coordinator, RN

TOP Case Management Program Manager

Assistant Director of Nursing (Home Health) – RN or LPN/LVN – $95,000–$115,000/yr FT | Las Cruces

Experienced Skilled Home Care RN Clinical Managers

RN Care Manager - Case Management - Shoreline Hospital

RN Clinical Manager

Director of Nursing

RN Utilization Management - Nights onsite

Part time Registered Nurse

MDS Coordinator RN - Sequim, WA

HOME CARE - RN CASE MANAGER

Patient Care Manager - Floater (RN)

RN Unit Manager

Director of Clinical Services (RN) Home Health

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