When you come to the University of Maryland St. Joseph Medical Center, you’re coming to more than simply a beautiful 37-acre, 218-bed suburban Baltimore, Maryland campus. You’re embarking on a professional journey that encourages opportunities, values a team atmosphere, and makes convenience and flexibility a priority. Joining our team of healthcare professionals means you’ll be contributing to a locally and nationally recognized institution. UM St. Joseph has been recognized by The Leapfrog Group as a grade ‘A’ hospital and by U.S. News & World Report as #3 in both the state and Baltimore Metro area, making UM St. Joseph the highest-ranking community hospital in Maryland. In addition, we’ve been consistently recognized as a top employer by Baltimore magazine.
General Summary
Onsite Position
The Utilization Review Nurse coordinates the care and service of selected patient populations across the continuum. He/ she works collaboratively with physicians and other members of the health care team to achieve the highest quality clinical outcomes with the most cost effective use of available resources. The Utilization Review Nurse assumes responsibility for an interdisciplinary process which assesses, plans, implements, monitors and measures the effectiveness of interventions to meet patients’ treatment and transitional needs.
Education
* 2 year / Associate’s Degree (Required)
* High School Diploma or GED (Required)
4 year / Bachelor’s Degree (Preferred)
Certification / Licensure / Registration
*State Registered Nurse License (Required)
CCM Case Management Certification (Preferred)
Experience and Skills
*2 - 4 years Familiarity with health care reimbursement systems (Required)
*4 - 6 years Acute care hospital or similar venue. (Required)
2 - 4 years Utilization Management (Preferred)
Required Skills: Strong Verbal Communications Skills, Strong Written Communications Skills, Excellent Interpersonal Skills, Medical Terminology
Job Responsibilities and Accountabilities:
Utilization Review Nurse
COLLABORATION: Collaborates with physicians and other health care professionals to promote appropriate use of medical center resources. Provides physicians and ancillary departments with data on treatment outcomes and avoidable delays in order to promote highest quality care. Communicates and negotiates with outside agencies, including insurance carriers, in order to obtain needed services for patients and accurate reimbursement for medical center. Works with interdisciplinary team to coordinate needed services to ensure efficient continuity of care.
DOCUMENTATION AND MEASUREMENT: Uses severity of illness/ intensity of
PATIENT CARE: Plans for care needs with active involvement of patient, significant others and hospital staff involved in treatment process. Oversees implementation of transition plans with support from internal and external agents. Monitors patients’ progress and adequacy of planning process through regular communications with patients and service providers. Provides information and support to patients and families, helping them access needed resources within the medical center and community.
PROBLEM SOLVING: Identifies problems or gaps in community resources that impact outcome and takes leadership role in efforts to effect changes. Takes a leadership role in identifying opportunities to reduce risks, both financial and clinical, through analysis of resource consumption outcomes.
All your information will be kept confidential according to EEO guidelines.
Compensation:
Pay Range: $39.52 - $50.65
Other Compensation (if applicable):
Like many employers, UMMS is being targeted by cybercriminals impersonating our recruiters and offering fake job opportunities. We will never ask for banking details, personal identification, or payment via email or text. If you suspect fraud, please contact us at careers@umms.edu.
...We Are At Certn, were revolutionizing background screening with The Worlds Easiest Background Checkfast, global, and powered by tech. Were not about outdated processes and red tape. Were about innovation, speed, and impact. If youre looking for a place where ownership...
Job Description Travailler avec le responsable du calcul des cots pour valider le calcul des cots standard effectu par les 4 units de production de l'entreprise (Amrique du Nord, Europe, Australie et Chine). Maintenir les lignes directrices, les modles et les politiques...
...This is where you save and sustain lives At Baxter, we are deeply connected by our mission. No matter your role at Baxter, your work makes a positive impact on people around the world. Youll feel a sense of purpose throughout the organization, as we know our work...
Grand Circle Corporation is hiring REMOTE Traveler Advisors (Inbound Call Center Sales Agents... ...Carolina, Texas, Utah, Washington.Why Work With Us?~Medical, Dental, Vision & Life... ...are bid on every 4 months, may have some weekend requirements.~Whether you travel often...
...Job Description We offer our Psychiatrists: ~ Flexible work schedules: Full-time and part-time (20 hours week+) available - set your own schedule!~ Hybrid models with on-site & telehealth. ~100% outpatient work. No nights, no hospital calls, no weekends....