Utilization Review Technician jobs in Washington, DC

Utilization Review Technician conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Technician reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Technician consults with nurses and physicians as needed. Position is non-RN. May require an associate degree or its equivalent. Typically reports to a supervisor. May require Registered Health Information Technician (RHIT). The Utilization Review Technician gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Utilization Review Technician typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

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Utilization Review Specialist
  • Department of Behavioral Healt
  • Washington, DC FULL_TIME
  • The incumbent functions as a Utilization Review Specialist in Health Information Management. The Utilization Review Specialist performs studies/reviews of medical records to monitor and to determine that the quality of clients’ treatment and care are maintained at the highest level. Examines and evaluates various components of client’s medical records to bill for Medicare reimbursement and commercial insurance for about 92 to 105 clients with insurance. These numbers may vary from month to month. When assessing the documentation, adheres to the policies and various guidelines, set by internal and external bodies, such CMS and JACHO. Attends treatment plan meetings, when necessary, in order to get collateral information from family members and case managers, to forward to commercial insurance companies. The incumbent is responsible for providing feedback to Utilization Review Committees, clinicians, clinical staff of various disciplines and Directors concerning the development and refinement of quality care criteria. Provides individual case discussions with attending clinicians and multidiscipline staff members to attain clarifications, to render recommendations, to tactfully persuade and negotiate oppositions and to facilitate acceptance of recommendations and modifications. Identifies problems, trends, and deficiencies, and factors requiring examination, evaluation and/or resolution as a result of reviewing various clinical documentations, data, methods and procedures related to admissions, continued hospitalization, treatment and care. Collects information and statistical data for compiling monthly reports which identify trends, problems, recommendations, achievements, resolutions and areas of high and low compliance. Submits annual written reports, consisting of statistical and graphic data, complied from the variety of studies performed in each division during the year. Distributes Level of Care Survey Forms each month to designated clinical staff member for completion and is responsible for attaining necessary corrections on forms returned with errors. Serves as liaison and resource person responsible for establishing and maintaining effective interactive communication and cooperation between the clinicians, multi-discipline clinical staff members and divisions’ Utilization Review Committees/Quality Assessment Committees. Adapts studies to stay in line with changing criteria and formats. Responsible for making recommendations, which have SEH-wide affect to clinicians, clinical staff of various disciplines and division directors regarding criteria compliance issues. Prioritizes reviews to ensure that wards are visited during convenient and appropriate times.

    RESIDENCY PREFERENCE AMENDMENT ACT OF 1988

    A person applying for a position in the Career Service, Educational Service, Management Supervisory Service, a line attorney position in the Legal Service (series 905), or an attorney position in the Excepted Service (series 905) who is a bona fide District resident AT THE TIME OF APPLICATION for the position may be awarded a 10-point residency preference over non-District applicants, unless the person declines the preference points. If selected, the person shall be required to present no less than 8 proofs of bona fide District residency and maintain such residency for 7 consecutive years from the effective date of the appointment. Failure to maintain bona fide District residency for the 7-year period will result in forfeiture of employment.

    This position IS in a collective bargaining unit and you may be required to pay an agency service fee through an automatic payroll deduction

    Position Designation: This position is deemed as “Security Sensitive” pursuant to Section 410 of Chapter 4 of the D.C. Personnel Regulations, in addition to the general suitability screening, individuals applying for or occupying security sensitive positions are subject to the following checks and tests:

    • Criminal background check;
    • Traffic record check (as applicable);
    • Consumer credit check (as applicable);
    • Reasonable suspicion drug and alcohol test; and
    • Post-accident or incident drug and alcohol test.

    Area of Consideration: Open to the Public

    Duration of Appointment: Permanent

    First Screening: April 8, 2024.

    Tour of Duty: 8:30 a.m. - 5:00 p.m. Monday to Friday

    Work Experience

    Advanced knowledge of mental health concepts, principles, practices, programs and operations based on professional training in health care methodologies. Detailed knowledge of techniques for record review methods, evaluation of clinical documentation and clinical interventions in the medical records review. Ability to work in a team environment and assist others such as third parties in understanding documentation requirements

    Qualifications

    In addition to meeting the basic requirements, this position requires one (1) year of experience equivalent to the next lower grade level equivalent to DS-11.

    Education

    Candidates must have completed four (4) years course of study in an accredited college or university. Bachelors or higher degree with major study in an academic field related to health or allied sciences pertinent to this position.

    Selective Placement Factor:

    Bachelor’s Degree in Nursing preferred.

    Work Environment

    Work is performed in a controlled environment and involves some exposure to moderate risk of accidents and requires following basic safety precautions. THIS POSITION REQUIRES A PRE EMPLOYMENT PHYSICAL, CONSUMER CREDIT CHECK & DRUG TEST.

    COVID-19 Vaccination

    The Government of the District of Columbia values the safety of our employees, our residents, and our visitors. In support of these values, if you are selected for this job you must be fully vaccinated against COVID-19, except when vaccination is not medically advised or violates your sincerely held religious beliefs in violation of EEO laws. If you are invited to join our team you must submit proof that you are fully vaccinated against COVID-19 to your initial HR representative, or you must request an exemption from your representative. New employees must either provide proof of vaccination or be granted a medical or religious exemption before working with the Government of the District of Columbia.

    EEO Statement: The District of Columbia Government is an Equal Opportunity Employer. All qualified candidates will receive consideration without regard to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, family responsibilities, matriculation, physical handicap, or political affiliation.

    Job Offers: Official Job Offers are made by the office of Human Resources Only.

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Utilization Review Nurse
  • medstar
  • Washington, DC FULL_TIME
  • Under the direction of The Director of UM/Appeals assists in the administration of utilization functions, the Utilization Review Nurse, assesses patient insurance/status to facilitate appropriate comp...
  • 1 Month Ago

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Utilization Review Specialist - PRN
  • Dominion Hospital
  • Falls, VA FULL_TIME
  • Introduction Last year our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a(an) Utilization Review Specialist - PRN with Dominion Hospital you can be a part ...
  • 1 Month Ago

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Senior Therapist - Youth Clinical Utilization Review
  • City of Alexandria
  • Alexandria, VA FULL_TIME
  • Senior Therapist – Youth Clinical Utilization ReviewThe City of Alexandria is located in northern Virginia and is bordered by the District of Columbia (Potomac River), Arlington and Fairfax counties. ...
  • 1 Day Ago

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Case Manager, Utilization Review, PRN (Weekends & Holidays)
  • University of Maryland Medical System
  • La Plata, MD PART_TIME
  • Job DescriptionGeneral SummaryThis is a PRN position with a requirement to work a minimum 2 weekend shifts per month & 1 holiday per year. MUST have 3-5 years clinical experience in a healthcare setti...
  • 17 Days Ago

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Licensed Practical Nurse (LPN) - Utilization Review
  • The Arora Group
  • Bethesda, MD FULL_TIME
  • Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in Bethesda, Maryland to provide care to Active Duty heroes, their families, and retirees at Walter Reed National Militar...
  • 1 Month Ago

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0 Utilization Review Technician jobs found in Washington, DC area

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App. Technical Specialist Senior (Onsite)
  • Serigor Inc.
  • Washington, DC
  • Job Title: App. Technical Specialist Senior (Onsite) Location: Washington, DC Duration: 12 Months+ Short Description: 11...
  • 3/28/2024 12:00:00 AM

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Radio Frequency Technical Specialist 1
  • M.C. Dean, Inc.
  • Vienna, VA
  • Job Overview: A Radio Frequency (RF) Technical Specialist 1 position may include Testing Plans, Field Coordination, Comm...
  • 3/27/2024 12:00:00 AM

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Embodied Carbon Technical Expert (Remote) Life Cycle Assessment
  • ICF International, Inc.
  • Reston, VA
  • LOB/Portfolio: Energy International Development/Energy Efficiency Location: US/Remote Are you an expert on the topic of ...
  • 3/26/2024 12:00:00 AM

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Advanced Manufacturing Technical Specialist
  • Guidehouse
  • Mc Lean, VA
  • Job Family: Technology Consulting Travel Required: Up to 25% Clearance Required: Active Secret What You Will Do: Join a ...
  • 3/26/2024 12:00:00 AM

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Enterprise Operations Center Technical Specialist
  • Dunhill Professional Search & Government Solutions
  • Ashburn, VA
  • This position is to support CBP! Must be able to obtain a public trust for the position. Location (Ashburn, VA) : Nights...
  • 3/26/2024 12:00:00 AM

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Systems Architect Senior Technical Specialist
  • Marathon TS
  • Reston, VA
  • MarathonTS is seeking a Systems Architect Senior Technical Specialist to support our Federal customer in the Washington,...
  • 3/26/2024 12:00:00 AM

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Veterinary Assistant/Tech/Expert in-home pet care (part-time)
  • ALEXANDRIA PET CARE INC
  • Alexandria, VA
  • Job Description Job Description APPLY FOR A PHONE INTERVIEW: 5-minute application at our website: https://alexandriapetc...
  • 3/25/2024 12:00:00 AM

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Compensation Project Manager and Technical Specialist
  • PRM Consulting Group, Inc.
  • Washington, DC
  • PRM Consulting Group, Inc. is seeking a highly skilled and detail-oriented individual to join our team as a Compensation...
  • 3/25/2024 12:00:00 AM

Washington, D.C. is located in the mid-Atlantic region of the U.S. East Coast. Due to the District of Columbia retrocession, the city has a total area of 68.34 square miles (177.0 km2), of which 61.05 square miles (158.1 km2) is land and 7.29 square miles (18.9 km2) (10.67%) is water. The District is bordered by Montgomery County, Maryland to the northwest; Prince George's County, Maryland to the east; Arlington County, Virginia to the south; and Alexandria, Virginia to the west. The south bank of the Potomac River forms the District's border with Virginia and has two major tributaries: the An...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Technician jobs
$69,871 to $97,495
Washington, District of Columbia area prices
were up 1.3% from a year ago

Utilization Review Technician in Winston Salem, NC
When considering cost of living, this places Durham, NC as 3rd out of the 4 largest nearby metros in terms of quality of life for Utilization Review Technicians**.
January 02, 2020
Utilization Review Technician in Fairbanks, AK
Current National Pharmacy Technician Certification (PTCB, ExCPT or NCCT) required.
February 03, 2020
Utilization Review Technician in Little Rock, AR
Based on our compensation data, the estimated salary potential for Utilization Review Technician will increase 16 % over 5 years.
February 07, 2020