RN Utilization Review

MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C. region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It’s how we treat people.https://careers.medstarhealth.org/careers-home/jobs/146651?lang=en-us

Conducts admission concurrent and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. Collaborates with medical staff and ancillary hospital disciplines to ensure high-quality patient care in the most efficient way.

Conducts admission concurrent and retrospective case reviews to meet hospital objectives of high-quality patient care in the most efficient way Strives to meet the department goals adheres to organizational policies procedures and quality standards. Complies with rules and regulations set forth by the governmental and accrediting agencies. Collaborates with medical staff physician advisor social workers and other ancillary hospital disciplines to meet patients' health care needs in the most cost-effective way. Performs patients' medical record reviews document pertinent information and communicate with third party payors in a timely fashion to ensure proper hospital reimbursement and eliminate unnecessary denials. Implements strategies to avoid potential denials by communicating with all the key stakeholders including attending physician. If necessary non-coverage ABN MOON letters and other appropriate documents as per organizational governmental and accrediting organizations policies and regulations. Actively participates in IDRs Length of Stay and other meetings as per hospital policies. Identifies potential risks pertaining to patients' care and communicates with appropriate hospital discipline including risk management quality safety and infection control. Serves as a resource to the health care team by educating the health care team through in-services staff meetings and formal educational settings in areas of utilization management. Demonstrate current knowledge of State and Federal regulatory requirements as it pertains to the utilization review process. Identifies dynamics of neglect/abuse and reports to the appropriate in-house departments and governmental agencies.