Utilization Management Specialist Ii

THE MEDICAL HEART OF MARYLAND

Treating over 330,000 patients every year, the University of Maryland Medical Center is at the vital core of Maryland’s health care system and community. We’re known for our prestigious expertise in innovative research and education, along with the talented staff and advanced centers that make it all possible. The R Adams Cowley Shock Trauma Center, the world’s first center dedicated to trauma, treats more than 7,500 critically injured patients a year with an incredible 97 percent survival rate. We also have one of the nation’s largest kidney and pancreas transplant programs at The Joseph and Corinne Schwartz Division of Transplantation, home to Maryland’s first steroid-free protocol and pancreas/kidney transplant. From our National Cancer Institute-designated UM Marlene and Stewart Greenebaum Cancer Center to The University of Maryland’s Children’s Hospital, one of the largest pediatric centers in the state, we are dedicated to saving and transforming lives.

Under general supervision, provides utilization review and denials management for an assigned patient case load. This role utilizes nationally recognized care guidelines/criteria to assess the patient’s need for outpatient or inpatient care as well as the appropriate level of care. The role requires interfacing with the case managers, medical team, other hospital staff, physician advisors and payers.

Education and Experience

• Prior Utilization Management experience preferred.
• Minimum of 12 months experience in case management or utilization management required.
• BSN preferred.
• Licensure as a Registered Nurse or other equivalent health care license in the state of Maryland, or eligible to practice due to Compact state agreements outlined through the MD Board of Nursing, is required.
• Proficiency with MCG criteria preferred.
• Minimum of 2 years Med/Surg experience. Experience across a wide variety of acute hospital care preferred (ICU, IMCU, ED).

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