Utilization Review Nurse Prn

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!
Requisition #: 376785
Location:
5755 Cedar Ln.
Columbia, MD 21044
Shift:
Casual (8 hours)
Day Shift; 9:00am - 5:30pm
Weekends Required: Yes
two weekend shifts per month
Exempt
Position 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 is required.
Licensure/Certification:
Must maintain current RN License in the state of Maryland.
Required Work 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 and Abilities:
Must possess excellent interpersonal and communication written and verbal skills necessary to gather and exchange data (both internally and externally) with key professionals.
Knowledge of medical terminology, anatomy and physiology, diagnosis, surgical procedures, and basic disease processes.
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.
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.
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.
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Diversity and Inclusion are Johns Hopkins Medicine Core Values. We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.
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Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employer. 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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