RN Utilization Review

ID: Shift: Day 5x8-Hour (08:00 - 16:30) Description: Utilization Review RNMust have current utilization review experience within the last Start Prefer Local candidates in the DC area60 Mile traveler radius*This position will be working out of the Medstar Georgetown facility starting May 1 2026 Modified Time:5/11/2026 12:00:00 AM Account Manager: Brooke Insko Account Manager Email: COVID-19 Vaccine: Not Required Flu Vaccine: Required - No Exemptions Submittals:Low Job Requirements & Qualifications Previous Charge Experience : Preferred Years of Experience : 2 Patient Ratio Experience : Charting System Experience : Required Charting System Name : Any Community Hospital Experience : - LTAC Experience : - Trauma Level I Experience : - Trauma Level II Experience : - Travel Experience Required : - Certifications : BLS Valid RN license in the District of Columbia; or M CCM - Certified Case Manager*Skills : Acute Hospital Long Term Acute Care/Rehab/Skilled Nursing* Concurrent Review Continued Stay Reviews Retrospective Review Utilize InterQual Criteria Utilize Milliman Guidelines CMS: Centers for Medicare and Medicaid Services CPT (Current Procedural Terminology) coding and billing Department of Health DRG (Diagnosis Related Groups) HEDIS (The Healthcare Effectiveness Data and Information Set) Measures HIPAA guidelines (Health Insurance Portability and Accountability Act) ICD 10 Coding NCQA (National Committee for Quality Assurance) OSHA The Joint Commission/ Core Measure/National Safety Goals Workers Compensation Admission Criteria Care coordination Discharge Planning Admission Criteria Unit Details Staffing & Scheduling Scheduling Type : - Patient Ratios Days : - Patient Ratios Nights : - Patient Ratios Weekends : - Float Required : - Call Required : - Weekend Coverage : - Number of Weekend Shifts Per Contract : - Pre-Approved Time Off : - Orientation Hours : - Facility & Patient Care Details Patient Age Groups : - Daily Census : - Number of Visits Per Day : - Number of Rooms : - Number of Beds : - Additional Unit Information Interdisciplinary Support : - Patient Diagnoses : Chronic diagnoses (High Risk Pregnancy Postpartum DM CHF COPD Asthma obesity/overweight All Behavorial Health etc.)- CM make calls to enrollees in Washington DC area to complete comprehensive assessments developing care plans and ongoing management within the EMR (guiding care/Healthedge). Special Procedures/Unit Details : Process includes: assessmentplanning coordinating and implementation. Monitors for timely provision of services. Assists hospital case managementstaff with discharge planning as referrals to Case Management as evidence-based standards in making coverage determinations in individual patient cases; Identifies and reportspotential coordination of benefits subrogation third party liability workers compensation cases etc. Identifies qualityrisk or utilization issues to appropriate MedStar personnel. Special Equipment : Responsible for evaluating the necessity appropriateness and efficiency of the use of medical services procedures and for clinical review of acute care services based on Medically Necessity criteria the management of quality healthcare resources for achievement of desired outcomes and coordination of alternative levels of care in a timely and in the mostcost-effective have experience as complex Case Manager preferably NCQA experience. #Tier4 Travel Compliance Please review the following submittal requirements carefully: Local Guidelines The local radius is 60 miles . A candidate s address must match their driver s license when determining local status and a copy of the driver s license must be provided at the time of submittal. Local candidates are accepted at a lower rate. Please reach out to the AM or EC for local rate information. Licensure (Required at Time of Submission) DC Locations: Must have a DC license in hand. Some units will accept a pending DC license (see job description to confirm). A later start date may be accepted if the traveler has applied for DC licensure. MD Locations: Must have either a compact license or an MD license. Some units will accept a pending MD license (see job description to confirm). A later start date may be accepted if the traveler has applied for MD licensure. RTO (Requested Time Off) No RTO is permitted during the first two weeks of the assignment. RTO must be included at the time of submittal and cannot be changed once the profile has been sent to the manager for review. Amount of RTO: No more than 7 days per 13-week contract. Certifications L D RNs: C-EFM NCC certification is required at the time of submittal. Return Staff Policy Nurses with previous MedStar employment must have been separated for a minimum of one year before returning as a traveler. Submittals Candidates may be submitted to only one MedStar location at a time. Interview Process Manager interviews are not guaranteed. Travelers must be comfortable proceeding without an interview. Any traveler questions should be directed to the AM. References Two (2) supervisor references are required. Clinical Review All submittals are reviewed by the clinical team even if not listed on Aya Offer. Compliance Requirements Candidates are assigned facility-and unit-specific Sitel modules upon hire which must be completed within one week of signing their contract. Failure to complete them within this timeframe may result in cancellation. Labs and DS appointment must be completed within 48 hours of signing. Failure to complete them within this timeframe may result in cancellation. Candidates are encouraged to plan ahead to prevent conflicts with vacations or work schedules. Candidates in the following specialties must pass the Relias EKG Rhythm Interpretation Exam for clearance achieving at least an 80% overall score and 100% on lethal rhythms: BICU Cardiac Cardiac Stress Testing Cardiac Tele Cardio Thoracic ICU CCU COVID ICU Critical Care Bedside Monitor Critical Care Float Critical Care Transport CVICU CVPICU ECMO EP Lab ER ER Holding ICU IMC IR LTAC ICU LTAC MS Tele LTAC Telemetry MICU MS/Tele MS/Tele Float Neuro ICU NICU NICU Transport PCU PCU Float PCU/Oncology Pediatric Cardiology Pediatric Critical Care Float Pool Pediatric ER Pediatric MICU Pediatric PCU Pediatric Stepdown Pediatric Telemetry PICU SICU Stepdown Stepdown Cardiac Stepdown Neuro Tele Float Telemetry Trauma ICU Modules : Modules are billable up to 4 hours any additional time beyond this is non-billable and must be margined. The average module duration is 12 hours. Modules are completed pre-start and potentially during orientation and can vary by specialty Modules are recorded via transcripts Submittal Details: #Tier4 Travel CompliancePlease review the following submittal requirements carefully:Local GuidelinesThe local radius is 60 miles. A candidate s address must match their driver s license when determining local status and a copy of the driver s license must be provided at the time of candidates are accepted at a lower rate. Please reach out to the AM or EC for local rate (Required at Time of Submission)DC Locations:Must have a DC license in units will accept a pending DC license (see job description to confirm). A later start date may be accepted if the traveler has applied for DC Locations:Must have either a compact license or an MD license. Some units will accept a pending MD license (see job description to confirm). A later start date may be accepted if the traveler has applied for MD (Requested Time Off)No RTO is permitted during the first two weeksof the must be included at the time of submittal and cannot be changed once the profile has been sent to the manager for of RTO: No more than 7 days per 13-week &D RNs:C-EFM NCC certification is required at the time of Staff PolicyNurses with previous MedStar employment must have been separated for a minimum of one yearbefore returning as a may be submitted to only one MedStar locationat a ProcessManager interviews are not guaranteed. Travelers must be comfortable proceeding without an traveler questions should be directed to the (2) supervisor references are ReviewAll submittals are reviewed by the clinical team even if not listed on Aya RequirementsCandidates are assigned facility-and unit-specific Sitel modules upon hire which must be completed within one week of signing their to complete them within this timeframe may result in and DS appointment must be completed within 48 hours of to complete them within this timeframe may result in cancellation. Candidates are encouraged to plan ahead to prevent conflicts with vacations or work in the following specialties must pass the Relias EKG Rhythm Interpretation Exam for clearance achieving at least an 80% overall score and 100% on lethal rhythms:BICUCardiacCardiac Stress TestingCardiac TeleCardio Thoracic ICUCCUCOVID ICUCritical Care Bedside MonitorCritical Care FloatCritical Care TransportCVICUCVPICUECMOEP LabERER HoldingICUIMCIRLTAC ICULTAC MS TeleLTAC TelemetryMICUMS/TeleMS/Tele FloatNeuro ICUNICUNICU TransportPCUPCU FloatPCU/OncologyPediatric CardiologyPediatric Critical Care Float PoolPediatric ERPediatric MICUPediatric PCUPediatric StepdownPediatric TelemetryPICUSICUStepdownStepdown CardiacStepdown NeuroTele FloatTelemetryTrauma ICU Modules:Modules are billable up to 4 hours any additional time beyond this is non-billable and must be margined. The average module duration is 12 are completed pre-start and potentially during orientation and can vary by specialtyModules are recorded via transcripts Guaranteed Hours: Contract Weeks:91