Utilization Review Specialist - Remote Metro DC Area RN

Vega Consulting is staffing several Utilization Review Specialists for our direct Healthcare client. Prefer candidates be located in the Metro DC Area. These are 6-month contract-to-hire, 100% remote roles. Medicare/Medicaid/DSNP experience is strongly preferred candidates must hold a compact license for Maryland.

The Utilization Review Specialist will perform prospective, concurrent and retrospective reviews for authorization, appropriateness of care determination and benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts, mandates, medical policy, evidence based published research, national accreditation and regulatory requirements contribute to determination of appropriateness and authorization of clinical services both medical and behavioral health.

Candidates job Requirement:

• Maryland BCBA license OR
• Virginia BCBA license OR
• Washington DC BCBA license
• UM experience
• RN/LPN state licensing or compact
• Education Level: Bachelor's Degree
• Education Details: Nursing
• Medicare/Medicaid/DSNP experience
• 5 years Clinical nursing experience
• 2 years Care Management

If you are a RN or LPN seeking a remote based position, select "Apply Now" and a Vega Staffing Specialist will reach out to you.