Utilization Management Nurse; RN - Part Time

Position Objective
:
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.

• Chart Review
  :
  Reviews the medical record by applying utilization review criteria to assess clinical, financial, and resource utilization; enters clinical review in EPIC; maintains close communication with external reviewers, care coordinators, and providers; reconciles and records days authorized in EPIC.
• Denial Management
  :
  Monitors and identifies patterns or trends in utilization management; monitors potential and actual denials and collaborates with care coordinators for follow‑up; documents actions taken to avoid denial; assists the Care Coordinator in communicating with the patient denied hospital days toward resolution and discharge.
• Care Coordination
  :
  Collaborates with the Care Coordinator to achieve optimal and efficient patient outcomes while decreasing length of stay, avoidable delays, and denied days; utilizes Physician Advisor and administrative personnel for unresolved issues; identifies opportunities for expedited appeals and collaborates with the care coordinator and Physician Advisor to resolve payer issues.
• Process Improvement Initiatives
  :
  Participates in nursing unit and department clinical outcome projects as well as process improvement initiatives of care management.

• Bachelor’s of Science in Nursing or Associate’s degree in Nursing with equivalent experience. BSN must be achieved within 5 years of the start date.
• Three years of clinical nursing in an acute care hospital setting.

• Current RN license from the Maryland Board of Nursing.

There is a reasonable expectation that employees in this position will be exposed to blood‑borne pathogens. The physical demands and work environment described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

$34—$55 USD

• Medical, Dental, and Vision Insurance
• Retirement Plan (with employer match for employees who work more than 1000 hours in a calendar year)
• Paid Time Off
• Tuition Assistance Benefits
• Employee Referral Bonus Program
• Paid Holidays, Disability, and Life/AD&D for full‑time employees
• Wellness Programs
• Employee Assistance Programs and more
• Benefit offerings based on employment status

The above job description is an overview of the functions and requirements for this position. This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.