Rn Utilization Review-Prn Jobs

Location: Suburban Hospital, Bethesda, MD 20814
Category: Allied Health/Clinical Professional
Schedule: Day Shift
Suburban Hospital is a 228-bed, not-for-profit, community-based hospital in Bethesda, Maryland. Suburban Hospital is a member of Johns Hopkins Medicine and has served Montgomery County and the surrounding area for more than 65 years. The designated trauma center for Montgomery County, Suburban Hospital is fully accredited by the Joint Commission and has earned ANCC Magnet Recognition for nursing excellence.
Our comprehensive benefits package is designed to help you balance work with life so you can focus on what matters most-your well-being and that of your loved ones. Some of our benefits include:
Dependent Child Tuition Assistance
Educational Assistance Program
Two retirement plans: Retirement Income Plan and 403(b) Savings Plan
Affordable Healthcare options
7 paid holidays each year
Paid Days Leave (PDL)
Flexible Spending Accounts
and more
https://jhhsbenefits.com/
GENERAL SUMMARY : The UR Care Coordination - Registered Nurse (RN) evaluates timeliness and appropriateness of patient care within the hospital setting for Observation or Inpatient Admission. The UR CM RN will evaluate the need for hospitalization through out the stay communicating with the Case Manager, physicians, and Insurance Companies. Timely reviews with the Insurance Company will be completed and followed up. Denials will be reported to PA and any other Clinical Reimbursement CM as directed.
EDUCATION AND EXPERIENCE REQUIRED :
Licensed to practice as a Registered Nurse in the State of Maryland. Graduate of an accredited Nursing program.
Bachelor's Degree or an equivalent combination of education and experience. Master degree preferred.
Minimum of 2 years clinical experience in acute care setting along with one or more years' experience Care Coordination performing discharge planning from the inpatient or skilled facility setting and one or more years' experience conducting inpatient utilization management and case coordination applying industry standard criteria (e.g., InterQual and Milliman).
Current CPR Certification required.
Johns Hopkins Health System and its affiliates are an Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regards 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.