UTILIZATION REVIEW NURSE - PRN Job at LifeBridge Health, Baltimore, MD

WXFrc1FOVURhQ1dwSGEvMDJTWllkRjdTTmc9PQ==
  • LifeBridge Health
  • Baltimore, MD

Job Description

UTILIZATION REVIEW NURSE - PRN

Baltimore, MD

SINAI HOSPITAL

UTILIZATION REVIEW

PRN - Weekends - Day shift - 8:00am-4:30pm

RN Other

83284

Posted:
June 14, 2024

Summary

Position Summary: 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.

Essential Functions - 

Chart Review Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource consumption.

Denial Management Monitors and identifies patterns or trends in utilization management.

Care Coordination Coordinates with the Care Manager to achieve optimal and efficient patient outcomes, while decreasing length of stay and avoid delays and denied days.

Qualifications/Requirements - 

Education/Knowledge:Basic professional knowledge; equivalent to a Bachelor's degree; working knowledge of theory and practice within a specialized field Education/Knowledge:

Education Discipline:

Minimal degree requirement: Bachelor of Science in Nursing. (BSN's from CCNE accredited schools)

Certification or Licenses:

Required Maryland Registered Nurse License

Experience:

Medical terminology (Frequently)

Nursing Process skills based on MD Nurse

Practice Act (Frequently)

Critical thinking skills (Frequently) Midas (Frequently)

Healthstream (Occasionally)

Utiization Review Criteria (Frequently)

Microsoft Office Suite (Frequently)

Basic computer skills (Frequently)

Cerner (Frequently)

Standard Office Equipment (Frequently)

Additional Comments Work from home will be 95% or greater. Training/remediation may be onsite with occasional onsite meetings

Additional Information

As one of the largest health care providers in Maryland, with 13,000 team members, We strive to CARE BRAVELY for over 1 million patients annually. LifeBridge Health includes Sinai Hospital of Baltimore, Northwest Hospital, Carroll Hospital, Levindale Hebrew Geriatric Center and Hospital and Grace Medical Center, as well as our Community Physician Enterprise, Center for Hope, Practice Dynamics, and business partners: LifeBridge Health & Fitness, ExpressCare and HomeCare of Maryland.

Share:

Job Tags

Permanent employment, Relief, Weekend work, Day shift,

Similar Jobs

Acuren Inspection, Inc.

Rope Access Technician Job at Acuren Inspection, Inc.

Position Summary: Acuren is currently seeking Rope Access Technicians to support our operation in Port Lavaca, TX. We are seeking local candiates to promote and train within. The successful candidates must be local to Corpus Christi, TX or surrounding area. While... 

Opa Insurance Management Pllc

INSURANCE AGENT ( P&C) Bi-lingual is a Plus Job at Opa Insurance Management Pllc

 .... We are looking for a successful Sales Representative to sell insurance and other property and casualty products. You must be persistent...  ...of $65,000+ a year. GEICO is the #1 auto insurance company in the state of Arizona. With one of the highest close ratios in... 

Quality Mobile Home Services

General Construction Apprentice Job at Quality Mobile Home Services

 ...Lake Elsinore, CA is looking to hire a full-time General Construction Apprentice to improve...  ...laborers. Are you highly motivated? Do you want to work for the largest and fastest-...  ...You pay close attention to details while helping the crew complete remodel and... 

Moran Towing Corporation

Barge Supervisor Job at Moran Towing Corporation

 ...for over 160 years. Starting in 1860 as a tugboat company, we have grown from those roots to become a dominant provider of commercial ship docking services, marine transportation, LNG support operations, environmental recovery, and commercial diving services. While... 

AllSTEM Connections

Construction Safety Manager Job at AllSTEM Connections

Job Description Job Description Summary: The Production Supervisor/Manager plays a key role in overseeing and coordinating the activities of production and operations teams to ensure efficient and high-quality output. Key Responsibilities: Motivate employees...