Utilization Review No Experience Jobs in Reston, VA

Registered Nurse I - Washington, DC (#R10290)

• Location: Washington, DC 20001
• Employment Type: Temporary / Part-Time (As-Needed)
• Hourly Rate: $52 per hour

About Greenlife Healthcare Staffing:

Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated to connecting healthcare professionals with top-tier opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals.

Position Overview:

Provides medical case management for the Public Sector Workers’ Compensation Program and Return-to-Work Program, including clinical assessment, care coordination, utilization review, medical documentation, and return-to-work planning.

Why Join Us?

• Competitive Compensation: Earn $52 per hour providing specialized medical case management for workers' compensation and return-to-work programs.
• Comprehensive Benefits: Temporary, part-time (as-needed). No work on District holidays or administrative closure days without prior written approval.
• Work Schedule: Part-Time / As-Needed (PTE), Monday-Friday.
• Professional Growth: Gain valuable experience in a collaborative, innovative, and supportive environment within a government office setting.
• Impactful Work: Contribute to a mission-driven organization dedicated to improving outcomes for injured workers through comprehensive medical case management and return-to-work planning.
  

Key Responsibilities:

• Provide comprehensive medical case management for public-sector workers’ compensation and return-to-work programs.
• Assess injured workers’ clinical status, treatment plans, functional abilities, and recovery progress.
• Develop, implement, monitor, and revise individual case management plans that support recovery and safe return to work.
• Coordinate care among injured workers, treating physicians, specialists, rehabilitation providers, employers, supervisors, claims examiners, and agency representatives.
• Review medical records, treatment plans, utilization requests, and supporting documentation for medical necessity, appropriateness, and workers’ compensation compliance.
• Conduct utilization review, treatment-plan review, and medical-billing review.
• Identify claims appropriate for return-to-work initiatives and support transitional duty assignments and workplace accommodations.
• Establish return-to-work status, projected recovery timelines, maximum medical improvement targets, work restrictions, and functional capacity recommendations based on medical evidence and provider input.
• Monitor injured workers before and after return to work and communicate case status and treatment progress to stakeholders.
• Prepare medical status reports, case summaries, recommendations, and claim-support documentation.
• Provide consultation, guidance, and training on medical management, return-to-work strategies, injury prevention, and transitional duty.
• Present medical findings and professional recommendations during claim reviews, mediations, hearings, and other proceedings.
• Maintain complete case records and safeguard confidential medical and personnel information.
• Perform other related duties supporting the workers’ compensation and return-to-work programs.

Greenlife Healthcare Staffing - Empowering Healthcare Professionals, Enriching Lives

Requirements

Qualifications:

• Job Qualifications & Certifications:
• Graduation from an accredited professional nursing program recognized by the applicable state accrediting authority.
• Current Registered Nurse license in the District of Columbia.
• At least one year of specialized professional nursing experience involving medical assessment, planning, implementation, utilization review, and evaluation of patient progress.
• Clinical experience in orthopedics, neurology, rehabilitation, or utilization review.
• Skills:
• Clinical assessment, medical case management, care planning, and utilization review.
• Workers’ compensation medical issues, healthcare regulations, return-to-work planning, and treatment review.
• Medical-record analysis, professional documentation, and case-status reporting.
• Microsoft Office and electronic medical or claims systems.
• Analytical, interpersonal, presentation, and written and verbal communication skills.
• Confidential information handling and privacy compliance.