Utilization Review Nurse - Part-Time

Location: Howard County General Hospital, Columbia, MD 21044
Category: Allied Health/Clinical Professional
Schedule: Day Shift
Join an amazing global healthcare organization!
Excellent compensation package!
Awesome benefits, including dependent tuition reimbursement!
Job Summary:
The Utilization Review (UR) Nurse is responsible to the Manager, Utilization Management. This
individual performs UR and Payor management activities, which include prospective and/or
retrospective chart and clinical systems review to measure UR issues that affect reimbursement
for the patient's hospital stay or visit. Responsibilities include medical record review,
communication with third party payors, third party payor initial denials, and special projects
which are coordinated and directed by the UR Payor Management Team Leader. May design
and initiate special projects as supervised by Manager, Utilization Management.
Education:
Graduate of an accredited school of nursing
BSN or Bachelors degree in Health Care Related Field experience is required.
Licensure/Certifications:
1. Must maintain current RN License in the state of Maryland.
2. Must maintain current CPR certification.
Experience:
Minimum of three (3) years of relevant clinical experience required, of which demonstrated
abilities in the areas of discharge planning, utilization, and quality management is
preferred.
Experience in two or more clinical areas are preferred.
Knowledge/Skills:
1. Must possess excellent interpersonal and communication written and verbal skills necessary
to gather and exchange data (both internally and externally) with key professionals.
2. Knowledge of medical terminology, anatomy and physiology, diagnosis, surgical
procedures, and basic disease processes.
3. Analytical ability required to gather data, decide on conformity based on predetermined
criteria, identify problems and refer for resolution. Awareness of licensing and accreditation
standards.
4. Ability to assess medical records and make determinations on length of stay and proper
procedures in accordance with policies and procedures, with experience in assigned
specialty.
5. Proficiency in keyboard entry/typing and in use of copier, fax machine, personal computer;
MS Office, Excel, and knowledge of clinical and financial computer systems.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
We are committed to providing a healthy and safe environment for our patients, visitors and staff members. The Johns Hopkins Hospital has a tobacco-free at work policy. Employees must refrain from using any tobacco products during their work shifts - including while at lunch or on breaks, and whether they are on or off campus.
Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action 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.
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