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Utilization Nurse

Location : Washington DC
Job Type : Temp/Contract
Hours : Full Time
Required Years of Experience : 3
Required Education : BSN
Travel : No
Relocation : No

Job Description :


  • Assumes responsibility for high level screening in regards to initial admission assessment and any ongoing concurrent assessment of designated patients as assigned; monitor level of care through communication with direct nursing care givers, care management team, physicians, patient and family members, and other members of the health care team.

  • Ensures initial admission reviews are completed and submitted to payer in a timely manner, same admission day or within first working day of admission; obtain certified days for patient’s presenting signs and symptoms and or documented primary diagnosis with treatment plan with the confirmation of level of care and admission status (patient type) appropriateness throughout the patient’s hospital stay.

  • Investigates with resolution of unauthorized clinical days and payment denials by payer for clinical services, same working day; front-end denial prevention prior to patient discharge.

  • Assumes responsibility for the completion of the Medicaid process for patient admission, continued stay, discharge and or post-acute services approval.

  • Works collaboratively with physicians to improve the overall quality of clinical documentation reflects the patient’s presenting severity of illness for hospitalization, and to establish accurate assignment of patient status orders (observation, inpatient), concurrently, throughout the patient’s hospital stay.

Required Qualifications :

Minimum Requirements:

  • Must have at least 2 years of recent hospital/managed care UR experience

  • Must have 3-5 years of RN clinical experience

  • Must have completed BSN

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