RN Utilization Management - Gainesville Virginia

Company: MedStar Health
Location: Gainesville, Virginia
Posted On: 03/21/2026

MedStar Health is seeking a dedicated RN Utilization Management to join our not-for-profit healthcare team. This role is pivotal in ensuring that all patient care provided meets the required standards of efficiency, effectiveness, and quality. The position demands a meticulous approach to monitoring and evaluating healthcare services to optimize both patient outcomes and resource utilization. Ideal candidates will share our patient-first philosophy and commit to improving healthcare delivery within the D.C.-Maryland-Virginia region. Evaluate patient care for appropriateness and efficiency based on established criteria and guidelines. Collaborate with healthcare providers to coordinate patient care and optimize the use of resources. Review patient records and treatment plans to ensure compliance with healthcare regulations and standards. Discuss necessary changes in care with healthcare teams and insurance providers. Stay informed on the latest healthcare practices and regulations. Prepare and present reports on patient outcomes and resource utilization to healthcare management. Strong analytical and decision-making skills Excellent interpersonal and communication skills Proficient in medical software and healthcare databases In-depth knowledge of healthcare regulations and insurance policies Medical Insurance Dental Insurance Vision Insurance Life Insurance 401k Valid RN license Certification in Case Management or Utilization Review preferred but not required. More...

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