Position Summary : Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information.
Provides intervention and coordination to decrease avoidable delays and denial of payment.
Essential Functions -
- Chart Review Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource consumption.
- Denial Management Monitors and identifies patterns or trends in utilization management.
- Care Coordination Coordinates with the Care Manager to achieve optimal and efficient patient outcomes, while decreasing length of stay and avoid delays and denied days.
Qualifications / Requirements -
Education / Knowledge : Basic professional knowledge; equivalent to a Bachelor's degree; working knowledge of theory and practice within a specialized field Education / Knowledge :
Education Discipline :
Minimal degree requirement : Bachelor of Science in Nursing. (BSN's from CCNE accredited schools)
Certification or Licenses :
Required Maryland Registered Nurse License
Experience :
- Medical terminology (Frequently)
- Nursing Process skills based on MD Nurse
- Practice Act (Frequently)
- Critical thinking skills (Frequently) Midas (Frequently)
- Healthstream (Occasionally)
- Utiization Review Criteria (Frequently)
- Microsoft Office Suite (Frequently)
- Basic computer skills (Frequently)
- Cerner (Frequently)
- Standard Office Equipment (Frequently)
Additional Comments Work from home will be 95% or greater. Training / remediation may be onsite with occasional onsite meetings
PI249699353
Utilization Review Nurse
A company is looking for a Utilization Review Nurse responsible for conducting utilization review work for emergency admissions and continued stay reviews. ...
Utilization Review Nurse (rn) - Prn
Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information. Must possess strong critical thinking skills, have an ability to perform clinical/chart review and abstract information efficiently. ...
Utilization Review Nurse - Prn
Chart Review Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource consumption. Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information. Denial Management Monitors and identifies pattern...
Utilization Review Nurse - Prn
Chart Review Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource consumption. Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information. Denial Management Monitors and identifies pattern...
Travel Registered Nurse - Utilization Review - Relocation to Memphis, TN
Do you thrive in a dynamic, fast-paced environment and enjoy the flexibility of travel nursing? If so, we have an exciting opportunity for you! We are seeking a dedicated Travel RN specializing in Utilization Review to join our team. Are you an experienced Registered Nurse (RN) with a passion for en...
Licensed Psychiatric Nurse Practitioner
Remote Licensed Psychiatric Nurse Practitioner. We are excited to begin helping you if you are a fully-licensed, ANCC board-certified Psychiatric Nurse Practitioner with:. Are you a licensed Psychiatric Nurse looking to launch a private practice, or grow your existing practice? Headway can help you ...
Information Systems Project Manager 2 - Security Clearance Required
Responsibilities include, but are not limited to: * Ensuring all projects follow project management best practices by developing project plans, timelines, budgets, progress status and ensure all projects are on schedule, on budget, with high quality or have a corrective action plan * Conducts analys...
Project Manager - Security Clearance Required
ManTech is currently seeking a motivated Senior Project Manager to join our team in Annapolis Junction, MD. Work with the higher-level program or Project Manager, if applicable, to provide effective and efficient management of the contractor's effort. Are you interested in detecting internal and ext...
Registered Nurse (RN) Med-Surg Ortho
Licensed Registered Nurse credentialed from the Maryland Board of Nursing or current home state. Please note, benefits and benefits eligibility can vary by position, exclusions may apply for some roles (for example: Travel, PRN, Short-Term Option, etc. As an associate, you will be a part of a team t...
Travel Nurse RN - Case Manager - $1,492 to $1,797 per week in Baltimore, MD
TravelNurseSource is working with Fusion Medical Staffing to find a qualified Case Manager RN in Baltimore, Maryland, 21215!. Registered Nurse - Case Manager. Case Manager Registered Nurse travel assignment. Client in Baltimore, MD is looking for a Case Manager Registered Nurse to help them out for ...