Utilization Review Nurse - Insurance Setting

Join Our Team as a Utilization Review Nurse in the Insurance Setting!

Are you a skilled nurse looking to make a difference in the insurance industry? Recruitment Specialists, Inc. is seeking a dedicated Utilization Review Nurse to join our team in Washington, DC. As a Utilization Review Nurse, you will play a crucial role in ensuring quality care for patients while maximizing cost efficiency for insurance providers. Join us in making a positive impact on healthcare!

Daily Responsibilities:

• 13+ weeks, M-F, 40 hours
• Utilizes evidence-based standards in making coverage determinations in individual patient cases; Identifies and reports potential coordination of benefits, subrogation, third-party liability, workers' compensation cases, etc.
• Performs pre-authorization and pharmacy reviews and documents in PBMÆs system when assigned.
• Sends thorough reviews to the Medical Director as appropriate. Coordinates timely review decisions and notifications per policy, NCQA standards/guidelines, and District of Columbia Contract.

Required Skills:

• DC RN
• Utilization review experience
• Insurance experience preferred
• Experience with InterQual or MCG
• Cerner or EPIC experience

Pay Rate and Benefits:

• Hourly Rate Minimum $49.00 (Salary potential $98,000.00)
• Hourly Rate Maximum $51.00 (salary potential $102,000.00)
• 401(k) benefits

Company Information:

Since 1993, RSI has been using multiple proven recruitment channels and industry-driven campaigns to provide candidates for permanent, contractual, and temp-to-hire positions for healthcare clients throughout the country. We are committed to understanding our clients’ individual needs and our candidates’ career goals to help everyone we work with achieve the right hire rather than just fast placement. RSI helps healthcare employers break through the competition with innovative recruitment solutions to identify, seek, and hire the best candidates available.

Kayla Walsh- 

rsirecruit.com

Key Words: Utilization review Nurse, Registered nurse, milliman, MCG, InterQual