Utilization Review Nurse

Washington, District of Columbia

Employer: Medix
Industry: Care Management
Salary: Competitive
Job type: Full-Time
We are looking for a Registered Nurse experienced in Utilization Review, looking to work within a diverse population.

Some responsibilities include...
  • Assessing patient care, review medical records and care plans to make sure that treatments are necessary and effective. Evaluating how well resources are being used.
  • Deciding on coverage, determining if patient's healthcare insurance will cover specific care. Walk patients through their insurance options and limitations.
  • Collaborate with insurance companies, social work, and quality improvement teams
  • Making recommendations
  • Help determine how long a patient should stay in the hospital, and if the care plan is effective.
  • Evaluating clinical appeals, assess patient care services in clinical appeals to decide if they should be approved or denied
  • Looking at 15 cases a day, Pediatrics as well as adults form 18-25 of age


Looking for indivduals with...
  • Health plan experience
  • Hospital experience
  • Interqual or Miliman experience
  • Experience in health plans reviews (dermal medicine, home health, rehab)
  • Pediatric inpatient admissions is a plus
  • Authorization, long term care, skilled nursing, behavioral analysis is a plus


Training in person. After training, the obligation is one day per week in the office based on the employees decision to select.

Monday-Friday full time role

8:00-5:00pm
Created: 2024-09-08
Reference: 233734_1725671877
Country: United States
State: District of Columbia
City: Washington
ZIP: 20010

Similar jobs: