Utilization Review Registered Nurse

About the Role

Inova Healthsystem is seeking a dedicated and experienced Utilization Review Registered Nurse (RN) to join their team. This PRN (as needed) position is for the day shift every weekend, from 8:00 a.m. to 4:30 p.m. This is a remote position.

Inova is recognized as a national healthcare leader in safety, quality, and patient experience, and is consistently ranked as a top employer in the D.C. metro area and the nation.

Key Responsibilities

The Utilization Review (UR) Registered Nurse (RN) 1 PRN plays a crucial role in determining the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities using utilization management techniques. This role is responsible for timely regulatory compliance and facilitation of precertification and payer authorization processes. The UR RN also actively participates in clinical performance improvement activities.

• Collects and analyzes data for performance and outcome indicators, including resource and financial indicators such as case mix, Length of Stay (LOS), cost per case, and readmission rates.
• Identifies and addresses variances from care plans and care paths with physicians and the healthcare team, using concurrent variance data to drive practice changes and improve outcomes.
• Documents key clinical path variances and outcomes related to discharge planning and chronic disease planning.
• Collaborates with other disciplines to ensure effective patient management and utilizes pathway data to support this.
• Ensures safe patient care by adhering to policies, procedures, and standards, managing time, supplies, and maintaining productivity and accuracy.
• Promotes professional growth through mandatory/continuing education and skills competency.
• Supports department goals and contributes to organizational success.
• Collaborates and communicates with internal and external case managers and UR RNs.
• Understands pre-acute and post-acute resources and works closely with patient healthcare teams to coordinate care.
• Ensures healthcare and discharge plans meet the physical, social, and emotional needs of patients.
• Acts as a patient advocate to resolve barriers to care progression.
• Applies approved clinical criteria to monitor appropriateness of admissions, continued stays, and post-acute settings, documenting findings.
• Identifies at-risk populations using screening tools and established reporting procedures.
• Monitors LOS and ancillary resource use to achieve continuous improvement efficiencies.
• Refers cases and issues appropriately to resolve barriers to care progression.
• Communicates routinely with the interdisciplinary healthcare team regarding patient care plans, progress, concerns, problem-solving, and conflict resolution.
• Works with the multidisciplinary team to address system problems impeding progress and seeks consultation as needed to expedite care and facilitate discharge.
• Ensures critical elements of care plans are communicated to patients, families, and the healthcare team.

Minimum Requirements

• Education: BSN from an accredited school of nursing. If ADN, must complete BSN within 5 years of the start date.
• Experience: Minimum of 1 year of Registered Nurse clinical bedside nursing experience.
• Certification: Currently licensed as a Registered Nurse in Virginia or hold a privilege to practice in Virginia under the Enhanced Nurse Licensure Compact (eNLC). Basic Life Support (BLS) for Healthcare Provider certification from the American Heart Association is required upon start.

Preferred Qualifications

• Two (2) years of previous RN utilization review inpatient experience.
• Advanced computer skills and EPIC experience are strongly preferred.

Remote Eligibility

This position is eligible for remote work for candidates residing in VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV.

Featured Benefits

• Team Member Health: Medical, dental, and vision coverage, plus a robust wellness program.
• Retirement: Inova matches 5% of eligible contributions from day one.
• Tuition and Student Loan Assistance: Up to $5,250 annually for education and up to $10,000 for student loans.
• Mental Health Support: 25 free mental health coaching or therapy sessions per person, per year.
• Work/Life Balance: Paid time off, paid parental leave, and flexible work schedules.

Key skills/competency

• Utilization Review
• Registered Nurse
• Clinical Nursing
• Patient Advocacy
• Case Management
• Healthcare Services
• Medical Necessity
• Regulatory Compliance
• Performance Improvement
• Care Coordination