Utilization Review RN, Hybrid
Health Services for Children with Special Needs (HSCSN)Washington, District of Columbia, United States
Posted January 15, 2026
Full Time
About the Company
Health Services for Children with Special Needs (HSCSN) is the designated health-care plan provider for the District of Columbia's Child and Adolescent Supplemental Security Income Program (CASSIP). The organization delivers coordinated medical, behavioral, and social services to children and young adults up to 26 years old who receive Supplemental Security Income (SSI) in Washington, DC. HSCSN specializes in addressing the complex health requirements of children with special needs, emphasizing individualized care plans, interdisciplinary collaboration, and proactive health management. By integrating clinical expertise with community resources, the company ensures that beneficiaries receive the comprehensive support necessary to lead fulfilling, independent lives.
Job Description
Utilization Review RN will be responsible for preauthorization, initial and concurrent review of inpatient, behavioral health, home health care services using internal criteria, InterQual, and nationally recognized criteria sets. They will also be responsible for clinical review of pediatric and young adult members for all in-patient stays, respite, home care, outpatient, rehabilitative therapy, durable medical equipment, and long term care services.
Requirements
- High School Diploma or GED
- Bachelor's Degree
- 3 years of sound medical/surgical, home health care, pediatric and/or behavioral health experience
- 2 years of experience in utilization management in a managed care environment
