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utilization review nurse

4 months ago

Randallstown, Maryland, United States LifeBridge Health Careers Full time
UTILIZATION REVIEW NURSE (RN)
  • Location: Randallstown, MD
  • Employer: NORTHWEST HOSPITAL, NW CARE MANAGEMENT
  • Schedule: Full-time, Day shift (8:00am-4:30pm)
  • Job Type: RN Other
  • Job ID: 81988
  • Posted Date: March 21, 2024

Summary

Role Overview: As a Utilization Review Nurse, you will conduct concurrent and retrospective chart evaluations to gather clinical, financial, and resource utilization data. Your main focus will be on interventions and coordination to reduce avoidable delays and payment rejections.

Chart Assessment: Evaluate medical records using utilization review criteria to analyze clinical, financial, and resource usage.

Denial Oversight: Monitor and detect utilization management patterns and trends.

Patient Care Coordination: Collaborate with Care Managers to ensure optimal patient outcomes and efficiency, aiming to minimize length of stay and prevent delays and denials.

Requirements:

  • Essential professional knowledge with a Bachelor's degree level of education. Proficiency in theory and practice in a specialized field.
  • Minimum Degree: Bachelor of Science in Nursing.
  • Strong critical thinking abilities, skilled in clinical/chart review and efficient data abstraction.
  • 3-5 years of Utilization Review experience, including expertise in denials and appeals.

Additional Information

As a key healthcare provider in Maryland, with a team of 13,000 members, we are dedicated to CARE BRAVELY for over 1 million patients annually. LifeBridge Health comprises various medical facilities, including Sinai Hospital of Baltimore, Northwest Hospital, Carroll Hospital, and Levindale Hebrew Geriatric Center. We also partner with Grace Medical Center, Community Physician Enterprise, Center for Hope, Practice Dynamics, and businesses like LifeBridge Health & Fitness, ExpressCare, and HomeCare of Maryland.