Utilization Review Coordinator jobs in Maryland
Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Coordinator reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Coordinator consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). The Utilization Review Coordinator contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. To be a Utilization Review Coordinator typically requires 4 to 7 years of related experience. (Copyright 2024 Salary.com)
Recently Added Utilization Review Coordinator jobs
- Utilization Review - 630
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Baltimore, MD
FULL_TIME
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Utilization Review - 630As NeededDay 8 Hour Shifts (8:30 am-5:00 pm)0Req# 43127
JOB DESCRIPTION SUMMARY:
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 outcomes. Works collaboratively with interdisciplinary staff internal and external to the organization ensuring maximum reimbursement for the hospital through the utilization review process. Active participation and attendance in daily multidisciplinary rounds. Responsible for analyzing clinical information and performing timely concurrent and retrospective reviews using InterQual screening software to identify appropriate medical necessity, length of stay, and level of care based upon evidence based clinical guidelines.
Education Bachelor of Science in Nursing (BSN) OR Advanced Practitioner licensure
Experience
Seven (7) years diversified, progressive experience in acute care and/or other settings within the continuum required.
Two (2) years of Case Management which includes Utilization Review, Discharge Planning and working with Re-Admission Initiatives preferred.
Knowledge, Skills and Abilities
- Broad knowledge of medical treatment practices
- Knowledge of healthcare regulatory agency standards for health care organizations.
- Ability to operate independently and to balance multiple priorities.
- Strong interpersonal, and influencing skills necessary to interact effectively with physicians, payers, regulatory agencies, staff, and other health professionals
- Knowledge of InterQual and/or Milliman criteria
- Skill in using computer software programs
- Advanced skill in oral and written communication
- Advanced skill in critical thinking
- Ability to resolve complex problems
- Ability to remain calm under pressure and intense time constraints
- Ability to assess discharge needs for patients
Licensures, Certifications
- Current state of Maryland Registered Nurse, Physician Assistant, or Nurse Practitioner license
- Certification in Utilization Management and/or Care Management highly desired.
Physical Requirements
- Ability to sit, stand, stoop, and bend.
Working Conditions
- Primarily in an office environment, evaluating electronic medical records and performing electronic documentation and communication 70% of time. Remainder of time working with interdisciplinary staff,
Conditions of Employment
- Maintain current licensure and certification
GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law. - 1 Month Ago
- medstar
-
Clinton, MD
FULL_TIME
- The primary responsibility of the Utilization Review (UR) and Denials Management Nurse is to utilize clinical expertise to interface with contracted third party vendor, VPMA or designated Physician Ad...
- 1 Month Ago
- LifeBridge Health
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Randallstown, MD
FULL_TIME
- Summary Position Summary: Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to decrease avoidable ...
- 18 Days Ago
- GBMC HealthCare
-
Baltimore, MD
OTHER
- JOB DESCRIPTION SUMMARY: Under general supervision, utilize clinical knowledge and critical thinking skills to provide oversight of appropriate admission status and utilization of hospital resources f...
- 1 Month Ago
- Tuerk House
-
Baltimore, MD
FULL_TIME
- Tuerk House is proud to be acknowledged by Newsweek as a top recovery center in Maryland. as one of “America’s Best Addiction Treatment Centers” for the past two years!Come and join and grow with The ...
- 24 Days Ago
- Korak Healthsource Group
-
Glen Burnie, MD
FULL_TIME
- Additional InformationAll your information will be kept confidential according to EEO guidelines.
- 1 Month Ago
Utilization Review Coordinator jobs at Popular Companies
- Christus Health
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Santa fe, NM
- Description POSITION SUMMARY: Registered Nurse uses approved screening criteria (MCG®/CMS Inpatient List) to determine t...
- 4/24/2024 12:00:00 AM
- BayMark Health Services
-
Deerfield Beach, FL
- Description Position at BayMark Health Services Residential - Utilization Review Coordinator Role and Responsibilities M...
- 4/23/2024 12:00:00 AM
- Foundations Behavioral Health
-
Doylestown, PA
- Foundations Behavioral Health is currently hiring a full-time Utilization Review Coordinator to support our UM Departmen...
- 4/22/2024 12:00:00 AM
- Carrus Hospital
-
Frisco, TX
- Carrus Care Frisco mental health clinic serving the pediatric and adolescent population, is seeking a Utilization Review...
- 4/22/2024 12:00:00 AM
- Transdev Inc.
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Fairfax, VA
- Utility Supervisor Job Description OVERVIEW: The Utility Supervisor reports directly to the Maintenance Manager in fulfi...
- 4/22/2024 12:00:00 AM
- Rad Diversified
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Exton, PA
- Job Description Job Description RAD Diversified is a GREAT place to work! Here’ s what we offer: Comprehensive Healthcar...
- 4/22/2024 12:00:00 AM
- TheraMatrix
-
Pontiac, MI
- Job Description Job Description Duties and Responsibilities: Initial authorizations of outpatient physical therapy servi...
- 4/21/2024 12:00:00 AM
- Foundations Behavioral Health
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Doylestown, PA
- Foundations Behavioral Health is currently hiring a full-time Utilization Review Coordinator to support our UM Departmen...
- 4/20/2024 12:00:00 AM