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Utilization Review Nurse- In Patient

Job Attributes

Job Id:

20176

Job Category:

Clinical & Life Sciences

Job Location:

Annapolis, MD  21401

Security Clearance:

Not Defined

Business Unit:

Piper Companies

JOB DESCRIPTION

Piper Clinical Solutions is seeking a motivated Inpatient Utilization Review Nurse in Anne Arundel County, MD to support a local health system with utilization management and health services coordination activities.

Responsibilities for the Inpatient Utilization Review Nurse:

 

  • Responsible for the utilization management and review of inpatient services for assigned hospital floors
  • 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 providers and nurses from assigned locations to assess denials or missing clinical documentation
  • Responsible for discharge planning for patients
  • Conduct root cause analysis to identify, monitor, and create measurable trends for re-admission levels

Requirements for the Inpatient Utilization Review Nurse:

 

  • 2+ years of nursing experience in an acute care hospital setting
  • Experience with utilization review in a hospital-based setting
  • Current RN licensure in Maryland
  • Associate’s degree in Nursing required

 

Compensation for the Inpatient Utilization Review Nurse:

 

 

Please send all qualified resumes to: idusci@pipercompanies.com

 

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:

20176

Job Category:

Clinical & Life Sciences

Job Location:

Annapolis, MD  21401

Security Clearance:

Not Defined

Business Unit:

Piper Companies