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Inpatient Utilization Review Nurse

Job Attributes

Job Id:

17322

Job Category:

Clinical & Life Sciences

Job Location:

Glen Burnie, MD  21060

Security Clearance:

Not Defined

Business Unit:

Piper Companies

JOB DESCRIPTION

Piper Clinical Solutions is seeking a motivated Inpatient Utilization Review Nurse in Baltimore, MD to support a local health system with utilization management and coordination activities with outside hospitals

Responsibilities for the Inpatient Utilization Review Nurse:

 

  • Responsible for the utilization management and review of inpatient services for assigned outside hospitals
  • Responsible for assessing individual cases and making determinations for medical necessity
  • On-site concurrent review, clinical management, and care coordination
  • Issue reports reflecting inpatient variances
  • Weekly meetings with Medical Directors from assigned hospital locations to assess denials
  • Responsible for discharge planning for certain patient cases
  • Conduct root cause analysis to identify, monitor, and create measurable trends for re-admission levels

Requirements for the Inpatient Utilization Review Nurse:

 

  • 3+ years of nursing experience in an acute care hospital setting
  • Experience with health plan and utilization review
  • Experience with utilization management review and affiliated legal and medical issues
  • Current RN licensure in Maryland
  • Associate’s degree in Nursing required

 

Compensation for the Inpatient Utilization Review Nurse:

 

 

Keywords:

 

Utilization review, registered nurse, milliman, interqual, ICD-9, ICE-10, CPT, HCPCS, DRG, APC, CPT, pre-pay, acute care, health insurance, health plan, health care, medical review, nurse, manager, intake, outpatient, medical review, home care, RN, CCM, Certified case manager, case management, medicare, medicaid, advance med, aerial, cms, tri care, healthsuite, advantage md, ushfp, ehp, priority partners, hostpital, discharge planning

 

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Job Id:

17322

Job Category:

Clinical & Life Sciences

Job Location:

Glen Burnie, MD  21060

Security Clearance:

Not Defined

Business Unit:

Piper Companies