RN Utilization Review Specialist – Weekend Shifts

MedStar Health’s Washington Hospital Center; Columbia (MD); On-site; USD 59,000 - 98,000; Full time

Job summary

MedStar Health’s Washington Hospital Center is seeking an experienced RN for utilization review. The role conducts admission concurrent and retrospective reviews to ensure appropriate admit status and level of care, collaborating with medical staff and payors to optimize patient care and reimbursement.

The position requires acute UR experience, availability for 4 weekend shifts per month, and consistent in-person training.

Qualifications

• RN with acute care experience in utilization review.
• Strong problem-solving and analytical abilities.
• Excellent verbal and written communication with multiple stakeholders.
• Proficiency in standard hospital information systems and office software.

Responsibilities

• Conducts admission concurrent and retrospective case reviews to ensure appropriate admit status and level of care.
• Collaborates with medical staff, physician advisors, social workers and other hospital disciplines to ensure high-quality, cost-effective patient care.
• Document review findings and communicate with third-party payors to support proper reimbursement and minimize denials.
• Identify risks in patient care and escalate to appropriate hospital teams and regulators as required.
• Educate health care teams through in-services and meetings on utilization management.

Skills

Problem-solving

Business acumen

Communication skills

Computer literacy

Education

Associate's degree in Nursing

Bachelor's degree in Nursing

Job description

MedStar Health’s Washington Hospital Center is seeking an experienced RN for utilization review. The role conducts admission concurrent and retrospective reviews to ensure appropriate admit status and level of care, collaborating with medical staff and payors to optimize patient care and reimbursement.

The position requires acute UR experience, availability for 4 weekend shifts per month, and consistent in-person training.