Utilization Review RN – Optimize Care & Costs

Capital Health Screening Centre; United States; On-site; USD 85,000 - 111,000; Full time

Job summary

Capital Health is seeking an Utilization Review RN to perform a variety of utilization and resource management activities aimed at quality, cost-effective patient care. Responsibilities include chart reviews for Medicare/Medicaid and payers, collaborating with care teams, and ensuring timely, appropriate levels of care while adhering to CMS guidelines.

The role supports efforts to optimize lengths of stay and resource use, with emphasis on documentation accuracy and regulatory compliance.

Responsibilities

• Performs utilization and resource management activities to promote quality, clinical and cost effective outcomes.
• Assesses patients' treatment plans, communicates to third party payers, and collaborates with healthcare team members.
• Promotes strategies to reduce length of stay and resource consumption while maintaining patient care quality.

Job description

Capital Health is seeking an Utilization Review RN to perform a variety of utilization and resource management activities aimed at quality, cost-effective patient care. Responsibilities include chart reviews for Medicare/Medicaid and payers, collaborating with care teams, and ensuring timely, appropriate levels of care while adhering to CMS guidelines.

The role supports efforts to optimize lengths of stay and resource use, with emphasis on documentation accuracy and regulatory compliance.