Top 111 Rn utilization management Jobs in Washington, Dc

RN Team Lead Utilization Review
MedStar Health —Clinton, MD
- $89,065 - $162,801 a year
- Full-time
- Nursing
- RN License
- Inpatient
2d
LTSS Service Coordinator-RN Clinician
Elevance Health —Springfield, VA
- $41.84 - $62.76 an hour
- Full-time
- Nursing
- RN License
- Working with individuals with disabilities
- Employee stock purchase plan
- Paid holidays
4d
Clinical Administrator (RN)
MedStar Health —Washington, DC
- $99,931 - $152,280 a year
- Weekends as needed
- Nursing
- Microsoft Excel
- RN License
Director of Nursing (RN)
Complete Care Careers —Silver Spring, MD
- Up to $150,000 a year
- Full-time
- Skilled nursing facility
- RN License
- Rehabilitation center
- Health insurance
- Dental insurance
Quick Apply
5d
RN Utilization Management
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
- Vision insurance
RN Case Manager
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
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
Utilization Management Nurse Consultant
CVS Health —Washington, DC
- $26.01 - $74.78 an hour
- Weekends as needed
- Remote
- Nursing
- RN License
- Computer literacy
- Health insurance
- Dental insurance
2d
Clinical Denials and Appeals RN
Guidehouse Managed Services LLC —Washington, DC
- $68,000 - $113,000 a year
- Full-time
- Nursing
- RN License
- Bachelor of Science
- Health savings account
- Paid holidays
Travel RN - Case Management/Utilization Review - Case Management
American Traveler —Silver Spring, MD
- $2,917 a week
- 8 hour shift
- Acute care
- Nursing
- RN License
Quick Apply
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
Quick Apply
Senior Consultant - Clinical Documentation Specialist
Deloitte —Washington, DC
- $110,700 - $218,300 a year
- Full-time
- Microsoft Word
- Nursing
- RN License
Registered Nurse - Mental Health
US Veterans Health Administration —Washington, DC
- $82,309 - $157,013 a year
- Online Application
- Background check
- Nursing
- Doctoral degree
- Paid holidays
- Loan repayment program
3d
Nurse Case Manager
Battelle —Arlington, VA
- Full-time
- Hybrid work
- Nursing
- RN License
- BLS Certification
- Wellness program
- Health insurance
Preservice RN - Remote in VA
UnitedHealthcare —Arlington, VA
- $28.94 - $51.63 an hour
- Full-time
- Remote
- Microsoft Word
- Microsoft Outlook
- RN License
HIM Clinical Document Specialist, UM Cap
University of Maryland Medical System —Largo, MD
- Full-time
- Medicine
- RN License
- Senior level
11d
Manager, Clinical Documentation Integrity
Adventist HealthCare —Gaithersburg, MD
- $105,664.42 - $158,496.00 a year
- Full-time
- Medicine
- Anatomy knowledge
- RN License
- Free parking
- AD&D insurance
Quick Apply
Hospital Case Manager
BridgePoint Continuing Care Hospital —Washington, DC
- $83,200 - $118,102 a year
- Full-time
- Master of Social Work
- Nursing
- RN License
- Continuing education credits
- Paid holidays
Quick Apply
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
13d
Registered Nurse (RN) Case Manager
Inova Health System —Fairfax, VA
- Part-time
- Acute care
- Nursing
- RN License
- Wellness program
- Paid parental leave
6d

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RN Team Lead Utilization Review

MedStar Health -
Clinton, MD

Apply Now

Job Details

Full-time
$89,065 - $162,801 a year
2 days ago

Qualifications

Inpatient experience
RN License
Acute care facility experience
Bachelor's degree
Bachelor's degree in nursing

Full Job Description

About this Job:

In-patient Utilization Review RN experience highly preferred. Candidate must live in the DC/Baltimore region

General Summary of Position
Supervises the daily activities of the Utilization Review Team. Manages daily assignment ensuring all UM tasks are completed each day. Collaborates with the physician nurse case manager social worker and other members of the health care team to meet individualized patient outcomes. Assists the Director in managing the daily departmental operations with the goal of maintaining adequate staffing levels and efficient workflow. Acts as a resource and mentor to the Utilization Review staff.

Primary Duties and Responsibilities

Supervises daily activities of UM team. Monitors and arranges for adequate staffing to ensure appropriate Utilization Review coverage for units. Monitors daily workflow issues and addresses issues related to workflow in collaboration with the director as necessary.
Acts as a resource and mentor for UM Team. Oversees the orientation of new UR Coordinators by establishing the plan and monitoring progress in conjunction with other staff as necessary Serves as a resource to all staff in areas of utilization review/management. Educates members of health care team through in-services staff meetings orientation and formal educational offerings. Completes continuing education to maintain knowledge base.
Collaborates with and assists the nurse case manager and social worker to meet the patients' continuing health needs in a high-quality cost-effective manner by identifying patients in need of case management. Participates in planning rounds as needed to address and communicate issues related to acuity level of patient LOS insurance and discharge needs.
Collects quality improvement data in accordance with approved indicators. Monitors and audits staff UM reviews for completeness and compliance with standards. Recognizes potential problems and provides education to staff.
Utilizes research methods to collect tabulate and analyze data in collaboration with the case management team medical staff and hospital performance improvement initiatives. Assists CM Leadership in implementing strategies to correct or modify trends seen through data analysis and outcome monitoring.
Confers and collaborates routinely with the physician advisor and attending physicians to resolve problems regarding acuity and level of care.
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.
Identifies insurance information obtains authorization communicates with financial counseling and assigns appropriate length of stay for admission.
Implements strategies to avoid denials including potential denial notification to attending physician. Issues letter of non-coverage for Medicare or third-party payers according to policies and procedures. Communicates utilization plans to case management team. Evaluates concurrent and retrospective denials for appeal opportunities. Generates appeal letters based on knowledge of clinical severity and intensity.
Manages the department in the Director's absence. Keeps Director informed about issues related to staffing and problem areas. Keeps Director informed about issues related to quality risk patient/family issues and concerns allocation of resources and vendor/payer issues. Assists the Director in monitoring performance issues. Contributes to the performance evaluation process by giving feedback to the Director and helping create professional development plans for UR Coordinators.
Participates in multidisciplinary quality and service improvement teams.
Performs admission reviews and subsequent concurrent reviews to determine the necessity for acute care by application of accepted criteria based on age specific needs. Interacts with and assists third party payer reviewers to facilitate appropriate care and ensure payment of services. Performs concurrent and retrospective reviews telephonically as required. Completes all forms and documentation necessary to support appropriate utilization of resources.

Minimal Qualifications
Education

Bachelor's degree in Nursing required

Experience

3-4 years clinical experience in acute care setting required
2 years Case Management or Utilization Management experience preferred
1-2 years leadership experience preferred

Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure the District of Columbia or State of Maryland depending on work location required
CCM - Certified Case Manager 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 in washington, dc

RN Team Lead Utilization Review

LTSS Service Coordinator-RN Clinician

Clinical Administrator (RN)

Director of Nursing (RN)

RN Utilization Management

RN Case Manager

RN In Hospital Transiton of Care Case Manager

Utilization Management Nurse Consultant

Clinical Denials and Appeals RN

Travel RN - Case Management/Utilization Review - Case Management

Clinical Reviewer DC

Senior Consultant - Clinical Documentation Specialist

Registered Nurse - Mental Health

Nurse Case Manager

Preservice RN - Remote in VA

HIM Clinical Document Specialist, UM Cap

Manager, Clinical Documentation Integrity

Hospital Case Manager

RN Case Manager Hybrid I/II

Registered Nurse (RN) Case Manager

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