Healthcare Resource Optimizer
2 days ago
This position requires a highly motivated and detail-oriented individual with a strong understanding of utilization management principles and practices. The ideal candidate will possess the following qualifications:
- Bachelor's degree in nursing
- Licensed as a registered nurse in the state of Maryland or eligible to practice due to compact state agreements outlined through the MD Board of Nursing
- One year of experience in case management or utilization management with knowledge of payer mechanisms and utilization management preferred
Key Responsibilities
- Perform timely and accurate utilization reviews for all patient populations
- Communicate with clinical care coordinators, physician advisors, medical teams, and payers as needed regarding reviews and pended/denied days and interventions
- Support concurrent appeals process through proactive identification of pended/denied days and implement the concurrent appeals process with appropriate referrals and documentation
- Ensure appropriate Level of Care and patient status for each patient
Compensation
The salary for this position ranges from $51.55 to $57.62 per hour. Additional compensation may be available based on experience and qualifications.
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