Utilization Review Registered Nurse (RN)
Company: MedStar Health
Location: Indian Head
Posted on: March 1, 2026
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Job Description:
MedStar Health, a leading not-for-profit healthcare organization
based in the D.C.-Maryland-Virginia region, is seeking a diligent
and knowledgeable Utilization Review Registered Nurse (RN) to join
our committed team. This role is crucial in maintaining the
alignment between patient care and regulatory standards, ensuring
efficient use of resources while delivering high-quality patient
outcomes. Candidates will be tasked with reviewing clinical
documentation, coordinating with healthcare providers, and
implementing care guidelines established by healthcare policies and
insurance providers. Our mission is to provide top-tier,
patient-first health services, and this position is a cornerstone
in achieving the optimal balance between patient needs and
cost-effective healthcare solutions. Evaluate patient records and
admissions for medical necessity and treatment effectiveness based
on established criteria Coordinate with physicians, nurses, and
other healthcare professionals to ensure optimal patient care and
compliance with healthcare regulations Liaise with insurance
providers to secure necessary approvals for procedures and
treatments Participate in case management meetings to discuss
patient treatment plans Ensure compliance with federal, state, and
institutional policies related to patient care and data privacy
Educate the healthcare team on utilization review processes and
updates in regulatory requirements Assist in the development and
implementation of utilization management programs Strong clinical
assessment skills Excellent communication and interpersonal skills
Proficiency in healthcare software and electronic health records
Ability to interpret and implement clinical guidelines Knowledge of
healthcare regulations and accreditation standards Medical
Insurance Dental Insurance Vision Insurance Life Insurance 401k
Valid and active Registered Nurse (RN) license in the state of
practice Certification in Case Management (CCM) or Certified
Professional in Utilization Review (CPUR) preferred but not
required
Keywords: MedStar Health, Washington DC , Utilization Review Registered Nurse (RN), Healthcare , Indian Head, DC
