Utilization Review Nurse

University of Maryland Medical System • Full-time • Towson, MD, US • 1w ago

Company Description

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.

Job Description

General Summary

The Care Manager 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 Care Manager assumes responsibility for an interdisciplinary process which assesses, plans, implements, monitors and measures the effectiveness of interventions to meet patients’ treatment and transitional needs.

Qualifications

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 Case management, discharge planning or utilization management (Preferred)

Required Skills: Strong Verbal Communications Skills, Strong Written Communications Skills, Excellent Interpersonal Skills, Medical Terminology

Job Responsibilities and Accountabilities:

CARE MANAGER

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 Job Description Page 2 of 3 services indexes to determine appropriateness of admissions, transfer and continued stays. Documents actions in medical record according to departmental guidelines and oversees process of exchange of information with other facilities/ agencies adhering to legal mandates regarding confidentiality. Measures effectiveness of interventions through direct communication with patients and caregivers and data collection of defined indicates (e.g. overall length of stay, readmission rates, feedback from referral services, etc.).

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.

Additional Information

All your information will be kept confidential according to EEO guidelines.

Compensation:

Pay Range: $39.52 - $50.65

Other Compensation (if applicable):

Review the 2024-2025 UMMS Benefits Guide

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.

Related Jobs

Public Health Nurse - Adult Evaluation and Review Services Program - Non-Merit

Baltimore County • Full-time • Towson, MD • $33 - $49 / hour • 2w ago

RN Utilization Review

Pay Schedule XIV, Grade R06, Regular Schedule: 30 hours per week. A vacancy exists in the Department of Health and Human Services, Adult Evaluation and Review Services Program. Non-Merit positions are not classifi...

2w ago

VIEW JOB

As-Needed Utilization Review Registered Nurse, Day Shift

GBMC Healthcare • Part-time • Towson, Maryland, United States • 3d ago

RN Utilization Review

Under general supervision, utilize clinical knowledge and critical thinking skills to provide oversight of appropriate admission status and utilization of hospital resources facilitating quality, cost-effective patient o...

3d ago

VIEW JOB

Utilization Review Registered Nurse, Monday-Friday 9:00AM-5:30PM or 8:00AM-4:30PM with weekend on-calls

GBMC Healthcare • Full-time • Towson, Maryland, United States • 3d ago

RN Utilization Review

Under general supervision, provides consultative support to the admitting teams concerning patient status determinations and utilization of hospital resources facilitating quality, cost-effective patient outcomes for pat...

3d ago

VIEW JOB

UTILIZATION REVIEW NURSE

LifeBridge Health • Full-time • Randallstown, MD, US • 1w ago

RN Utilization Review

Summary Utilization Review Nurse - Psych RN Experience Position Summary Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention an...

1w ago

VIEW JOB

UTILIZATION REVIEW NURSE PRN

LifeBridge Health • Per Diem • Baltimore, MD, US • 2w ago

RN Utilization Review

Summary JOB SUMMARY: Conducts initial, concurrent, and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to decrease avoidable delays and...

2w ago

VIEW JOB

Registered Nurse PreOp PACU II, Pool - Bethesda Endoscopy Center

SCA Health • Per Diem • Maryland, United States • 1w ago

RN PACU

Overview At SCA Health, we believe health care is about people – the patients we serve, the physicians we support and the teammates who push us forward. Behind every successful facility, procedure or innovation is...

1w ago

VIEW JOB

Hospital Operations Supervisor, Registered Nurse - (Nights/ Full-Time)

Sheppard Pratt • Full-time • Towson, Maryland, United States • 1d ago

RN Manager/Supervisor

As a Hospital Operations Supervisor you will: Oversees or shares oversight of hospital-wide nursing services during evening, night or weekend shifts. Reviews shift reports from preceding shifts to be apprised o...

1d ago

VIEW JOB

Float Registered Nurse, RN, Towson (Nights)

Sheppard Pratt • Full-time • Towson, Maryland, United States • 1m ago

As a Float Nurse (RN), you will: Be responsible for providing additional and/or relief coverage as indicated by staff shortage or patient status in varying patient care areas. Perform a full range of professiona...

1m ago

VIEW JOB

Registered Nurse (RN)

IntelyCare • Per Diem • Cockeysville, MD, US • $49 - $60 / hour • 1w ago

Make up to $60 per hour as a Registered Nurse (RN) in Cockeysville, MD and surrounding areas and get the scheduling freedom you've been looking for. As a nurse-founded company, we know how important flexibility and...

1w ago

VIEW JOB

Registered Nurse

Orchard Hill Rehabilitation and Healthcare Center • Full-time • Towson, MD, US • 1w ago

Join our team at Orchard Hillas an RN! Proudly supported by Marquis Health Consulting Services Full-time, part-time, and PRN opportunities available Same Day Pay! Responsibilities of RN: T...

Easily Apply

1w ago

VIEW JOB