Remote RN Utilization Review Nurse - Care & Compliance

MedStar Health; Washington (District of Columbia); Remote; USD 89,000 - 163,000; Full time

Job summary

MedStar Health in the Washington, DC area is seeking an experienced nurse for admission review to determine appropriate admit status and level of care. The role is remote but requires travel for regular meetings, with preference for candidates in the DC/MD/VA region.

You will collaborate with medical staff and payors to ensure high-quality, cost-effective patient care and compliance with utilization management policies.

Qualifications

• Associate's degree in Nursing is required; Bachelor's degree preferred.
• 3+ years' experience in acute care; 2+ years in case management/utilization review.

Responsibilities

• Conduct admission reviews to determine appropriate admit status and level of care.
• Collaborate with medical staff and other disciplines to ensure high-quality care.
• Document reviews and communicate with payors to secure proper reimbursement and avoid denials.
• Educate team on utilization management and regulatory requirements.
• Identify risks and participate in IDRs and Length of Stay meetings.
• Report neglect/abuse per policy.

Skills

Problem solving

Leadership

Communication

Computer skills

Education

Associate's degree in Nursing

Bachelor's degree in Nursing

Job description

MedStar Health in the Washington, DC area is seeking an experienced nurse for admission review to determine appropriate admit status and level of care. The role is remote but requires travel for regular meetings, with preference for candidates in the DC/MD/VA region.

You will collaborate with medical staff and payors to ensure high-quality, cost-effective patient care and compliance with utilization management policies.