Utilization Review Registered Nurse
- Job Title
- Utilization Review Registered Nurse
- Job ID
- WASHINGTON, DC 20002
- Other Location
With over 150 years of caring for our community and each other in the Washington DC area, Howard University Hospital has a world-renowned reputation for high-quality, patient-centric care. Howard University Hospital is the nation’s only teaching hospital located on the campus of a Historically Black University and has created a superior learning environment, with groundbreaking research and positive patient outcomes.
Howard University Hospital seeks to hire a Utilization Review Registered Nurse who will embrace our reach and historic tradition of excellence. If you want to make a difference in someone’s life every day, consider a position with a team of professionals who are doing just that, making a difference.
The Utilization Review Registered Nurse:
- Conducts timely clinical chart reviews and applies appropriate clinical criteria according to department protocols, payer contractual agreements and/or as assigned. Provide effective communication with third party payers.
- Reviews admission service requests as assigned for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Ensure compliance with Medicare and Medicaid regulatory requirements.
- Promotes quality care through the efficient/timely and effective use of hospital resources by applying special efforts in reviewing medical necessity of admission, length of stay, promptness of service, use of consultations and facilitation of effective discharge planning.
- Serves as an education and communication resource regarding utilization review, performance improvement and case mix reimbursement.
- Collaborates with payors, care providers and review organizations to ensure proper utilization of patient care resources for appropriate reimbursement. Identify and isolate challenging Diagnosis Related Groups (DRGs), other diagnosis or procedures and suggest methods for improvement.
- Maintains effective working relationships with internal and external stakeholders to include physicians, health care team, community providers, insurers and others.
- Networks with insurers to resolve those denial issues that can be managed successfully without appeal.
Qualified candidates will possess:
- Bachelor of Science degree in Nursing.
- Graduate of an accredited school of nursing.
- Current license to practice as a Registered Nurse in the District of Columbia.
- 3-5 years in Utilization Review and Case Management Discharge planning.
At Howard University Hospital our job is to care for you. We do this by offering:
Work life balance
Recognition and rewards for professional expertise
Competitive, comprehensive benefit plans offered (including health, disability, vacation, sick leave, and 403B retirement plan)
Free tuition for you and your dependent children.
Howard University Hospital requires all external applicants to be fully vaccinated for COVID-19 before commencing employment. External Applicants may be required to furnish proof of vaccination and, if offered, may elect to be vaccinated at a designated Howard University Hospital location.
- Required Skills
Bachelor of Science degree in Nursing.
Graduate of an accredited school of nursing.
Current license to practice as a Registered Nurse in the District of Columbia.
3-5 years in Utilization Review and Case Management Discharge planning.