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Outpatient Utilization Review Nurse

Job Attributes

Job Id:

17323

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 Outpatient Utilization Review Nurse in Baltimore, MD to support a local health system with utilization management and coordination activities with outside hospitals

Responsibilities for the Outpatient Utilization Review Nurse:

 

  • Responsible for the utilization management and review of outpatient services for assigned outpatient facilities (Home Health, Specialized Nursing Facilities, DME, Assisted Living, Rehabilitation Therapy)
  • 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 outpatient locations to assess denials and remediation
  • Responsible for coordination of outpatient services for individual patients
  • Conduct root cause analysis to identify, monitor, and create measurable trends for re-admission levels

Requirements for the Outpatient Utilization Review Nurse:

 

  • 4+ years of nursing experience in an acute care hospital setting
  • 1+ years of managed care and utilization review experience
  • Experience with physician clinical review
  • Experience with cost regulation and insurance claims payment a plus
  • Current RN licensure in Maryland
  • Associate’s degree in Nursing required

 

Compensation for the Outpatient Utilization Review Nurse:

 

  • Salary up to $85,000 based on meeting of requirements
  • Full Benefits: Health, Dental & Vision Insurance, PTO, Paid Holidays, Merit-Based Salary Increases, Educational Assistance and 401K

 

Keywords:

 

Utilization review, registered nurse, Milliman, interqual, 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, DME, SNF, specialized nursing facilities, assisted living, rehabilitation therapy, hospice, evidence of coverage, eoc, medical necessity

 

 

 

 

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Job Id:

17323

Job Category:

Clinical & Life Sciences

Job Location:

Glen Burnie, MD  21060

Security Clearance:

Not Defined

Business Unit:

Piper Companies