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RN Utilization Review- PRN Weekends
1 month ago
Collaborates with the physician, nurse case manager, social worker, and other members of the health care team to meet individualized patient outcomes. Performs concurrent, and retrospective medical record reviews based on approved screening criteria, knowledge of insurance coverage, and communication with the third-party payers. Ensures medical necessity determinations, service authorization and concurrent denials are managed effectively and financially responsibly.
Education
- Valid RN license in State of Maryland required and
- Bachelor's degree in Nursing preferred
- Clinical experience in acute care setting required and
- Experience with interqual and millimen preferred
- CCM - Certified Case Manager CCM preferred and
- ACMA preferred
- Verbal and written communication skills.
- Basic computer skills.
- Diagnostic and problem-solving skills.
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