Top 142 Rn Utilization Management Jobs in Fairfax, VA

RN In Hospital Transition of Care Case Manager
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- Psychiatry
Quick Apply
RN In Hospital Transiton of Care Case Manager
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Background check
- Nursing
- Microsoft Excel
Quick Apply
RN Case Manager
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
Trainer Clinical Operations MedStar Family Choice DC
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Background check
- Nursing
- RN License
Quick Apply
Remote Triage Nurse
GPW Health Center Inc —Woodbridge, VA
- $25.75 - $32.62 an hour
- Full-time
- Remote
- Bilingual
- Nursing
- RN License
- Health savings account
- Paid holidays
Quick Apply
Utilization Review Clinician - Behavioral Health
Centene —Washington, DC
- $27.02 - $48.55 an hour
- Weekends as needed
- Remote
- LMFT
- Nursing
- Addiction Medicine
- Paid holidays
- Health insurance
5d
Registered Nurse (RN) Outpatient Behavioral Health
Inova Health System —Sterling, VA
- 8 hour shift
- Hybrid work
- Nursing
- RN License
- Computer literacy
- Wellness program
- Paid parental leave
Clinical Reviewer DC
Comagine Health —Washington, DC
- $93,000 - $104,000 a year
- Full-time
- Hybrid work
- RN License
- Writing skills
- Mid-level
- Paid parental leave
- Health insurance
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RN Supervisor, Appeals, Managed Care, UM
Centene —Washington, DC
- $75,300 - $135,400 a year
- Full-time
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
4d
Clinic Nurse
George Mason University —Fairfax, VA
- Part-time
- Nursing
- RN License
- BLS Certification
Case Manager II
Children's National Hospital —Washington, DC
- $87,172.80 - $145,267.20 a year
- Weekends as needed
- Nursing
- RN License
- Customer service
- Commuter assistance
- AD&D insurance
RN Case Manager Hybrid I/II
Children's National Hospital —Washington, DC
- $77,584.00 - $129,292.80 a year
- Full-time
- Nursing
- RN License
- 3 years
- Commuter assistance
- AD&D insurance
Manager Case Management (Registered Nurse or Social Worker)
Inova Health System —Falls Church, VA
- Full-time
- Master of Social Work
- Nursing
- RN License
- Wellness program
- Paid parental leave
Nurse Case Manager-NOVA, VA
Managed Care Services, Inc. —Manassas, VA
- Full-time
- Nursing
- RN License
- Mid-level
- 403(b) matching
- Paid parental leave
Quick Apply
Case Management Program Manager (Registered Nurse OR Social Worker)
Inova Health System —Alexandria, VA
- Full-time
- Nursing
- RN License
- Hospital
- Wellness program
- Paid parental leave
Nurse CARE Manager, Wellness Center & Case Management
Marriott International, Inc —Bethesda, MD
- $84,000 - $147,500 a year
- Full-time
- CPR Certification
- Nursing
- Medication administration
- Commuter assistance
- Paid parental leave
1d
Travel RN - Case Management/Utilization Review - Case Management
American Traveler —Arlington, VA
- $2,917 a week
- 8 hour shift
- Acute care
- Nursing
- RN License
Quick Apply
Registered Nurse (RN) Case Manager 1
Inova Health System —Leesburg, VA
- Part-time
- Nursing
- RN License
- BLS Certification
- Wellness program
- Paid parental leave
Nurse Case Manager
Battelle —Arlington, VA
- Full-time
- Hybrid work
- Nursing
- RN License
- BLS Certification
- Wellness program
- Health insurance
Field RN Case Manager
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Management
- RN License

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RN In Hospital Transition of Care Case Manager

MedStar Health -
Washington, DC

Quick Apply

Job Details

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

Qualifications

RN License
Managing patients as a nurse case manager
Utilization management
Decision making
Resource utilization in healthcare

Full Job Description

About this Job:

General Summary of Position

An exciting new role has been added to the team, offering a unique opportunity to make a direct impact on patient outcomes at a critical point in care. The In-Hospital Transition of Care RN Case Manager partners closely with hospital discharge planners to coordinate patient care at discharge, ensuring seamless continuity across care settings and reducing avoidable readmissions through proactive coordination, patient education, and timely follow-up.

This position is based at either Washington Hospital Center or The Psychiatric Institute of Washington (PIW) and offers the opportunity to work across diverse patient populations, with flexibility to provide coverage at both locations.

In this highly collaborative and autonomous role, the RN Case Manager manages a complex caseload and takes ownership of case management program(s), driving high-quality, cost-effective outcomes while enhancing the patient experience. The role includes coordinating and managing care for members/enrollees, completing pre-authorization reviews to ensure medical necessity and timely access to services, and conducting pharmacy reviews aligned with the population served. Working alongside an interdisciplinary team, you will play a key role in discharge planning, connecting patients to the right resources, and ensuring smooth transitions across the continuum of care.

This is an excellent opportunity for a nurse who thrives in a fast-paced environment, values critical thinking and autonomy, and is passionate about improving care transitions and patient outcomes. We are committed to fostering a supportive, inclusive environment where associates from diverse backgrounds can grow, advance, and make a meaningful difference.

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.
Actively develops and manages complex case management cases and develops individualized plans of care according to NCQA standards/ guidelines and the District of Columbia Contract.
Acts as a liaison to MedStar Family Choice contracted vendors to facilitate care. Identifies gaps in contracted services and develops a plan to access care.
Acts as an advocate while assisting members/enrollees 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.
Assists hospital case management staff with discharge planning if applicable. Makes recommendation to alternate tier of Case Management programs or level of care as acuity necessitate.
Attends and participates in MFC staff meetings Clinical Operations department meetings Special Needs Forums work groups District/ community agencies meetings etc. as assigned. Provides input completes assignments and shares new findings with other staff. 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.
Provides face to face case management in the community as the member/enrollee's health necessitate.
Demonstrates behavior consistent with MedStar Health mission vision goals objectives and patient care philosophy.
Demonstrates skill and flexibility in providing coverage for other staff.
For assigned Case Management program(s) develops strategies assessment(s) and evaluation/goal tools according to NCQA standards/ guidelines and District of Columbia Contract for the population served. Utilizes standards/ guidelines to manage and document interactions for the program (s). Responsible for verifying that assigned program utilizes up-to-date standards in the medical and behavioral health community for the population served. Keeps informed about disease processes treatment modalities and resources.
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.
Identifies inpatients requiring additional services and initiates care with appropriate practitioners.
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 Operation department's policy.
Monitors utilization of all services for fraud waste and abuse.
Performs telephonic ACD line coverage for Clinical Operations' needs.
Enters authorization as appropriate to the program and sends the reviews to Medical Director as appropriate. Coordinates review decisions and notifications per policy NCQA standards/ guidelines and District of Columbia Contract for timely decision making.
Participates in meetings and on committees and represents the department and hospital in community outreach efforts.
Participates in multi-disciplinary quality and service improvement teams.

Minimal Qualifications
Education

Graduate of an accredited School of Nursing required and
Bachelor's degree preferred

Experience

1-2 years Case management experience required and
1-2 years UM or related experience required and
3-4 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 and/or the State of Maryland based on work location(s) Upon Hire required and
CCM - Certified Case Manager Upon Hire preferred

Knowledge Skills and Abilities

Verbal and written communication skills. Ability to use computer to enter and retrieve data. Ability to create edit and analyze Microsoft office (Word Excel and PowerPoint) preferred.

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

Work Location: In person

Quick Apply

Refine Your Search

Rn Utilization Management jobs in Fairfax, VA

RN In Hospital Transition of Care Case Manager

RN In Hospital Transiton of Care Case Manager

RN Case Manager

Trainer Clinical Operations MedStar Family Choice DC

Remote Triage Nurse

Utilization Review Clinician - Behavioral Health

Registered Nurse (RN) Outpatient Behavioral Health

Clinical Reviewer DC

RN Supervisor, Appeals, Managed Care, UM

Clinic Nurse

Case Manager II

RN Case Manager Hybrid I/II

Manager Case Management (Registered Nurse or Social Worker)

Nurse Case Manager-NOVA, VA

Case Management Program Manager (Registered Nurse OR Social Worker)

Nurse CARE Manager, Wellness Center & Case Management

Travel RN - Case Management/Utilization Review - Case Management

Registered Nurse (RN) Case Manager 1

Nurse Case Manager

Field RN Case Manager

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