Utilization Management RN

Location: Baltimore, MD
Date Posted: 11-26-2018
Utilization Review Nurse (RN) - Hospital
Baltimore, MD
*** Full-Time, Benefits Available, CONTRACT position, expected to last several months, or longer! ***

Utilization Review Nurse Job Summary: 
  • The Utilization Review Nurse is responsible for utilization management or prior-authorized treatments, and the utilization review of concurrent patient treatment.
  • The Utilization Review Nurse will performs reviews of services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.
  • Utilize clinical skills to provide and facilitate utilization review, continued stay reviews and utilization management of all cases based on clinical experience and recognized guidelines.
  • The Utilization Review Nurse will obtain the information necessary to assess a patient's clinical condition, identify ongoing clinical care needs and ensure that patients receive services in the most optimal setting to effectively meet their needs. 
Utilization Review Nurse Background: 
  • Current, valid, and unrestricted state Registered Nurse (R.N.) license.
  • CCM or CPUR or similar certification is preferred
  • Roughly 3-5 years acute care clinical nursing experience is required.
  • Around 2-3 years of acute care hospital case management, utilization review, or appeals experience.
  • Must have strong skills in medical assessment / medical record review; knowledge of coding a plus.
  • Knowledge of guidelines for Medicaid/Medicare and related state programs is required.
  • Experience using InterQual criteria for medical necessity, setting and level of care, and concurrent patient management.
  • Computer skills to include Microsoft Word, Excel, database use, and basic data entry.
410.983.9864 (CALL – TEXT – FAX)
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