6 days ago Be among the first 25 applicants This range is provided by Medix. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $40.00/hr - $46.00/hr Direct message the job poster from Medix Utilization Review Nurse (Hybrid – Washington, DC) We are seeking a detail-oriented and collaborative Utilization Review Nurse to join our team in a hybrid role supporting care coordination and service planning for home care patients. This position plays a key role in improving patient outcomes by reviewing long-term care assessments, adjusting service hours, and participating in team-based decision-making. Key Responsibilities: Conduct utilization reviews and evaluate care plans for patients receiving home care services Perform annual reviews of long-term care assessments to recommend service hour adjustments for enrollees Use Interqual criteria to assess eligibility for private duty nursing Collaborate with multidisciplinary teams during daily rounds (involving up to 30 participants) Document findings and care decisions using Guiding Care (EMR platform) Maintain accuracy, compliance, and integrity of reviews through strong critical thinking and attention to detail Position Highlights: Impactful Work : Help shape individualized care plans and influence service delivery for vulnerable populations Hybrid Flexibility : Work four days in-person at our MLK location , and enjoy one remote day (your choice) Consistent Hiring Path : Aligned with previous successful contract-to-hire arrangements Team-Oriented Culture : Collaborate in dynamic, fast-paced clinical rounds and interdisciplinary settings Qualifications (Must-Have): Active RN license in Washington, DC (ASN, BSN, or diploma RN accepted) Minimum 2 years of Utilization Management (UM) nursing experience Proficiency in Interqual utilization review criteria (required) Comfortable using electronic medical records , specifically Guiding Care Strong written and verbal communication skills, especially in group settings Preferred Skills: Bachelor of Science in Nursing (BSN) Experience working with health plans or managed care organizations (MCOs) Core Attributes for Success: Exceptional attention to detail and organization Solid critical thinking and problem-solving skills Empathy , patience, and professionalism in handling sensitive member data Flexibility to adapt to evolving protocols or caseloads Comfort in teamwork , especially during large-scale clinical discussions Seniority level Seniority level Not Applicable Employment type Employment type Full-time Job function Job function Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at Medix by 2x Inferred from the description for this job Medical insurance Vision insurance Disability insurance Paid paternity leave Paid maternity leave 401(k) Get notified about new Utilization Review Nurse jobs in Washington, DC . Washington, DC $61,470.00-$130,000.00 3 months ago Registered Nurse (RN) Part Time - $5000 Sign on Bonus Registered Nurse (RN) - Preop/PACU/PAT, Part time, $10k Sign on Bonus Registered Nurse (RN), PreOp, Part time, $12k Sign on Bonus Registered Nurse (RN), Day Shift, Home Health Silver Spring, MD $37.00-$55.00 3 days ago Registered Nurse/Mother-Baby / Couplet Care / Post Partum Registered Nurse/Mother-Baby / Couplet Care / Post Partum Registered Nurse - RN / Post Anesthesia Care Unit - RR Registered Nurse (RN) Outpatient- Oakton Primary Care District of Columbia, United States $42.00-$46.00 5 days ago Silver Spring, MD $40.00-$41.00 3 weeks ago Washington, DC $61,000.00-$130,000.00 4 months ago Registered Nurse - Occupational Health Center Lanham, MD $60,000.00-$121,000.00 2 weeks ago Silver Spring, MD $60,420.00-$106,040.00 2 months ago Quality Assurance Nurse (Registered Nurse) Registered Nurse (Non-Practicing) (Bethesda, MD) Registered Nurse - Ambulatory Care Pediatrics Registered Nurse Case Manager (full-time) Clinton, MD $2,011.00-$2,011.00 1 week ago Registered Nurse (RN) - Occupational Health Registered Nurse RN PACU Preop Full Time Day Registered Nurse (RN) Outpatient Pre-Procedural Registered Nurse - Behavioral Health Educator Registered Nurse (RN) - $7500 Sign On Bonus We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr Medix™
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