Utilization Management Registered Nurse

The multi-state Registered Nurse (RN), currently licensed and in good standing in the District of Columbia, Maryland, and Virginia, provides clinical and operational oversight for prior authorization and level-of-care determinations related to non-emergency transportation services. The RN is responsible for evaluating and investigating prior authorization requests to ensure appropriate medical necessity and determining the most suitable mode of transportation based on beneficiary needs. This role also serves as a critical clinical decision-maker for a nurse triage line, receiving transfers from local emergency services for individuals experiencing non-emergency medical conditions.

The RN assesses these cases in real time and appropriately routes beneficiaries to the nearest available non-emergency medical care setting, helping to reduce unnecessary emergency department utilization and improving care coordination. In collaboration with the Department of Disability Services and other stakeholders, the RN manages Intellectual and Developmental Disabilities (IDD) requests, oversees the Level of Need (LON) process, and ensures accurate determination of appropriate transportation resources. The position also supports the development and facilitation of education and training programs for transportation providers and contractor staff.