Top 43 Utilization review nurse Jobs in Washington, Dc

Field RN Case Manager
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Management
- RN License
RN Inpatient Case Manager Part-Time ( Emergency Dept )
MedStar Health —Olney, MD
- $89,065 - $162,801 a year
- Part-time
- Acute care
- Nursing
- Microsoft Excel
RN Team Lead Utilization Review
MedStar Health —Clinton, MD
- $89,065 - $162,801 a year
- Full-time
- Hybrid work
- Nursing
- RN License
- Hospital
Quick Apply
RN Utilization Review - PRN Weekends
MedStar Health —Clinton, MD
- $89,065 - $162,801 a year
- Weekends as needed
- Nursing
- RN License
- Hospital
4d
Utilization Reviewer
University of Maryland Medical System —Largo, MD
- $40.61 - $60.96 an hour
- Full-time
- Nursing
- RN License
- Hospital
9d
Utilization Management Reviewer
Amerihealth Caritas —Washington, DC
- $41.35 - $56.39 an hour
- Overtime
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Paid holidays
- Disability insurance
12d
Utilization Review Coordinator
Psychiatric Institute of Washington —Washington, DC
- $33.60 - $50.40 an hour
- PRN
- Psychiatry
- Pass drug screening
- Adults
- Health insurance
- Dental insurance
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
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
Clinical Review Specialist
Healthcare Legal Solutions LLC —Washington, DC
- $45 - $50 an hour
- Nursing
- RN License
- Certified Nurse Practitioner
Quick Apply
Registered Nurse - Utilization Management
Spectrum Healthcare Resources —Camp Springs, MD
- 8 hour shift
- Nursing
- RN License
- Mid-level
Quick Apply
9d
Clinical Care Coordinator
University of Maryland Medical System —Largo, MD
- $47.00 - $70.54 an hour
- Full-time
- Nursing
- RN License
- Hospital
- Paid time off
Special Operations Case / Nurse Case Manager Part-Time (National Capitol Region)
KBR —Alexandria, VA
- $49.31 - $54.64 an hour
- Part-time
- Nursing
- RN License
- Military
- AD&D insurance
- Health insurance
Medical Review RN
LifeHealth LLC —Washington, DC
- $45 an hour
- Part-time
- 18 years or older
- CPR Certification
- Nursing
Quick Apply
Quality Assurance and Utilization Review Manager
ASPEN OF DC INC —Washington, DC
- $33.65 an hour
- Nursing
- Microsoft Excel
- RN License
Quick Apply
Special Operations Nurse Case Manager / Case Manager Part-Time (National Capital Region)
KBR —Washington, DC
- $49.31 - $54.64 an hour
- Part-time
- Nursing
- RN License
- Military
- AD&D insurance
- Disability insurance
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
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
Nurse Case Manager
Battelle —Arlington, VA
- Full-time
- Hybrid work
- Nursing
- RN License
- BLS Certification
- Wellness program
- Health insurance
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

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utilization review nurse jobs near washington, dc

Field RN Case Manager

MedStar Health -
Washington, DC

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Job Details

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

Qualifications

Experience working with individuals with neurodevelopmental disorders
RN License
Interdisciplinary collaboration in health services social work
Bachelor's degree
Health services social work
Adults with developmental disabilities
Working with individuals with mental health conditions
Bachelor's degree in nursing

Full Job Description

About this Job: General Summary of Position
This position will be responsible for the Annual and periodically required Comprehensive Clinical Assessment as cited in section C.3.27.2 of the Department of Health Care Finance awarded contract. The Field RN Case Manager will be responsible for the District of Columbia Region. This position is responsible for up to 85% travel to our MedStar Family Choice District of Columbia Enrollees. The Field RN Case Manager serves as the central point of contact for MedStar Family Choice D.C. Case Management and conducts activities and functions required for this role. The Field RN Manager will be responsible for the referral of MedStar Family Choice Enrollees to other MedStar Family Choice programs as needed i.e. Maternal Health Behavioral Health Food Insecurity relief and Non-Medical Transportation. They are also responsible for the report of Enrollees requiring assistance with Medicare and/or Medicaid beneficiary support Medicaid for Nursing Home Placement Crime Victims Vocational Rehabilitation and any/all other third-party coverage including other available local state and federal programs.

Primary Duties and Responsibilities

Integrates physical health behavioral health social environmental into a single person-centered seamless system of care.
Promotes person-centered approach to service and care planning that honors each Member's priorities goals needs and preferences.
Encourages Enrollee engagement in the person-centered service planning process and the use of person-centered planning teams with expertise in community integration behavioral health and health and wellness.
Leverages providers community partners and local community resources to ensure comprehensive coordinated and culturally appropriate care for each member.
Provides service and support to maintain members in the least restrictive and most appropriate setting as possible.
Leverages the use of evidence-based practice guidelines clinical pathways technology solutions and clinical decision support tools.
Provides Case Management for designated member population to include support for self-direction nursing home transition transition of care and Utilization Management (UM) activities. Completes field-based member assessments and identifies activities and interventions based on the member needs of this continuum aligning the level of engagement and interventions with identified member needs.
Oversees daily weekly and monthly functions of Field Case Manager coordinating member assessments and establishing priorities as needed. This includes the duties clinical analysis documentation and follow up for member clinical reviews and other similar duties to effectively manage the MedStar Family Choice D.C. case managed member population.
Prepares and provides reports to manager(s) on work in progress and address any backlogs for resolution.
Responsible for informing members about annual required assessments in-person centered service planning processes service alternatives service delivery options e.g. opportunities for self -direction roles rights including MedStar Family Choice D.C Fair Hearing rights risks and responsibilities. Assists with fair hearing requests when needed and requested and to protect the members' health welfare and quality on an ongoing basis.
Collects the necessary information including at a minimum: member preferences strengths and goals to inform the development of the person-centered needs and the reevaluation of level of care annually or more frequently as needed.
Assists member with person-centered care plans.
Works with members to complete activities necessary to maintain MedStar Family Choice D.C. eligibility.
Explores coverage of services to address identified member needs through other sources including services provided under medical assistance Medicare or private insurance and other community resources.
Actively coordinates with other individuals and entities in the care delivery of member services for physical behavioral and support service needs.
MedStar Family Choice DC policies procedures training quality oversight and monitoring for staff and contracted field case managers will ensure consistency in the execution and delivery of our MFC Model of Care.

Minimal Qualifications
Education

Bachelor's degree in Nursing required

Experience

1-2 years At least 1 year working in social service or health care related setting required and
1-2 years Experience working with people with Developmental Disabilities HIV Behavioral Health and/or other related vulnerable populations required

Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure RN - Registered Nurse - State Licensure and/or Compact State Licensure Upon Hire required

Knowledge Skills and Abilities

Knowledge of the home and community-based service system and how to access and arrange for services
Ability to conduct field-based member assessments up to 85% of the time
Experience conducting Department of Health Care Finance needs assessments
Cultural competency and the ability to provide informed advocacy
Ability to interact with physicians and other health care professionals in a professional manner is required
Experience with section C.3.27.2 of the Department of Health Care Finance awarded contract

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

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Refine Your Search

utilization review nurse jobs in washington, dc

Field RN Case Manager

RN Inpatient Case Manager Part-Time ( Emergency Dept )

RN Team Lead Utilization Review

RN Utilization Review - PRN Weekends

Utilization Reviewer

Utilization Management Reviewer

Utilization Review Coordinator

Clinical Reviewer DC

Nurse CARE Manager, Wellness Center & Case Management

Clinical Review Specialist

Registered Nurse - Utilization Management

Clinical Care Coordinator

Special Operations Case / Nurse Case Manager Part-Time (National Capitol Region)

Medical Review RN

Quality Assurance and Utilization Review Manager

Special Operations Nurse Case Manager / Case Manager Part-Time (National Capital Region)

Case Manager II

Travel RN - Case Management/Utilization Review - Case Management

Nurse Case Manager

Registered Nurse (RN) Outpatient Behavioral Health

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