RN Case Manager Utilization Review

MedStar Health, a leading not-for-profit healthcare organization in the DMV area, is looking for a dedicated and compassionate RN Case Manager specializing in Utilization Review to join our team. In this role, you will be essential in managing patient care coordination, ensuring that all patients receive the necessary care within the appropriate setting and time frame. Utilizing both your clinical expertise and knowledge of healthcare policies, you will review treatment plans and determine the necessity and efficiency of services, all while upholding our patient-first philosophy. Assess patient care needs and develop care plans in collaboration with healthcare providers. Perform initial patient assessments and ongoing reassessments based on protocols and standards of care. Determine the appropriateness of inpatient and outpatient services following evidence-based guidelines. Collaborate with multidisciplinary teams to ensure effective communication between all caregivers and patients. Monitor patient progress and adjust care plans as necessary. Educate patients and families about treatment options and healthcare rights. Ensure compliance with federal, state, and local regulations and accreditation requirements. Document and maintain accurate records of patient interactions and decisions. Strong clinical judgment Proficiency in utilization review and case management software Excellent communication and interpersonal skills Ability to work effectively in a multidisciplinary team Knowledge of healthcare regulations and accreditation standards Medical Insurance Dental Insurance Vision Insurance Life Insurance 401k Current Registered Nurse (RN) license in the state of practice Certification in Case Management (CCM) preferred