Utilization Review RN: Quality Care & Cost Optimization

Capital Health (US); Hopewell (VA); On-site; USD 82,000 - 107,000; Full time

Benefits offered by this job

Medical Plan

Dental Plan

Vision Plan

Flexible Spending Account (FSA)

Retirement Savings and Investment Plan

Long Term Disability (LTD)

Paid Time-Off

Job summary

Capital Health is seeking an experienced Registered Nurse for Utilization Management to support quality and cost-effective patient care. You will review admissions, perform concurrent and retrospective reviews, and collaborate with payers and care teams to optimize resources while maintaining high standards of care.

The role requires strong clinical nursing background, knowledge of UR software, and familiarity with MS Office and EMR systems. 8-hour shifts and full-time status are included.

Qualifications

• Associate’s degree in nursing from an accredited program.
• Five years’ clinical nursing and three years quality management, utilization review or discharge planning experience.

Responsibilities

• Perform chart reviews to assess quality, timeliness and appropriateness of patient care.
• Conduct admission reviews for Medicare/Medicaid and private insurers to determine level of care.
• Gather data for continued stay utilization reviews and communicate with payers.
• Coaching physicians on accurate level of care determinations at hospital entry.
• Identify and implement strategies to reduce length of stay and resource use.

Skills

Utilization review

Quality management

Nursing experience

MS Office

EMR

Education

Associate’s degree in nursing

Tools

UR software

EMR

MCG guidelines

Job description

Capital Health is seeking an experienced Registered Nurse for Utilization Management to support quality and cost-effective patient care. You will review admissions, perform concurrent and retrospective reviews, and collaborate with payers and care teams to optimize resources while maintaining high standards of care.

The role requires strong clinical nursing background, knowledge of UR software, and familiarity with MS Office and EMR systems. 8-hour shifts and full-time status are included.