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Utilization Review Nurse
Job description
Utilization Review Nurse
Are you a LPN or an RN licensed in Washington, D.C. with Utilization Review experience? We are hiring for a Fully Remote Utilization Review Nurse to work with a leading healthcare organization in the DMV! Details are outlined below, interviews are actively going on, apply today!!
Overview
Ensure that patients receive the right care at the right time while also controlling healthcare costs and maintaining quality standards. Review patient records, treatment plans, and procedures to determine if the care being provided is medically necessary and aligned with established guidelines. Work closely with doctors, nurses, and other healthcare professionals to discuss care plans, suggest alternatives, and help coordinate care to prevent unnecessary treatments or hospital stays.
Day to day
Health plan experience
Hospital experience
Interqual is preferred. Miliman works as well.
Experience in health plans reviews (dermal medicine, home health, rehab)
Pediatric inpatient admissions is a plus
Authorization, long term care, skilled nursing, behavioral analysis would be a plus.
Looking at 15 cases a day.
Patient population - case load
Pediatrics as well as adults from 18-25
Can often see cerebral palsy, genetic issues, cancer, behavioral health (bipolar), substance abuse, will often be UR for Admissions with children's
Required Skills
-RN or LPN with experience
-UR in a health plan/insurance
-Interqual or Miliman experience
Nice to Have Skills
-Self motivated
-Productive
-Communication skills
Schedule
Monday through Friday 8:00AM-5:00PM
Pay Rate: $40.00-$46.00
Medix is acting as an Employment Agency in relation to this vacancy.