Registered Nurse -Utilization Review
About The Position
Advocate for appropriate care by reviewing admissions and service requests to ensure every patient receives the right level of medical necessity at the right time. Guide complex patient journeys through expert case management and consultation, providing a roadmap for high-quality outcomes in even the most challenging clinical situations. Support the frontline care team by resolving documentation and reimbursement hurdles, ensuring the hospital can focus its resources on direct patient care. Coordinate seamless transitions by collaborating with the healthcare team to build safe, effective discharge plans that set patients up for success long after they leave our facility. Maintain clinical integrity by overseeing compliance with federal and payer regulations, protecting our patients and our organization from administrative risk.
Requirements
- Registered Nurse credentialed from the Maryland Board of Nursing obtained prior to hire date or job transfer date required.
- Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.
Nice To Haves
- Professional Licensure: Must hold a current, active Registered Nurse (RN) license in the state of Maryland.
- Specialized Expertise: Proven experience in Utilization Management, Case Management, or Clinical Documentation Improvement within a healthcare setting.
Responsibilities
- Advocate for appropriate care by reviewing admissions and service requests to ensure every patient receives the right level of medical necessity at the right time.
- Guide complex patient journeys through expert case management and consultation, providing a roadmap for high-quality outcomes in even the most challenging clinical situations.
- Support the frontline care team by resolving documentation and reimbursement hurdles, ensuring the hospital can focus its resources on direct patient care.
- Coordinate seamless transitions by collaborating with the healthcare team to build safe, effective discharge plans that set patients up for success long after they leave our facility.
- Maintain clinical integrity by overseeing compliance with federal and payer regulations, protecting our patients and our organization from administrative risk.
Benefits
- Comprehensive health coverage: medical, dental, vision, prescription coverage and HSA/FSA options
- Financial security & retirement: employer-matched 403(b), planning and hardship resources, disability and life insurance
- Time to recharge: pro-rated paid time off (PTO) and holidays
- Career growth: Ascension-paid tuition (Vocare), reimbursement, ongoing professional development and online learning
- Emotional well-being: Employee Assistance Program, counseling and peer support, spiritual care and stress management resources
- Family support: parental leave, adoption assistance and family benefits
- Other benefits: optional legal and pet insurance, transportation savings and more
- Benefit options and eligibility vary by position, scheduled hours and location. Benefits are subject to change at any time. Your recruiter will provide the most up-to-date details during the hiring process.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
