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Utilization Review Nurse

Job Attributes

Job Id:

17566

Job Category:

Clinical & Life Sciences

Job Location:

Baltimore, MD  21230

Security Clearance:

No Clearance

Business Unit:

Piper Companies

JOB DESCRIPTION

Piper Clinical is currently looking for an Outpatient Utilization Review Nurse in Baltimore, MD to support a well-respected, medical and healthcare provider to ensure is cost-effective and high-quality care.

 

Responsibilities for the Outpatient Utilization Review Nurse Include:

  • Perform utilization review of outpatient services within assigned outpatient facilities (Home Health, Specialized Nursing Facilities, DME, Assisted Living, Rehabilitation Therapy)
  • Responsible for the review of claims to determine medical necessity & appropriate utilization of services
  • Acquire additional information if necessary to assist in level of care determination
  • Collaborate with the care coordinator to ensure appropriate level of care
  • Identifies and document delays in service
  • Conducts concurrent reviews in accordance with departmental policy and as private payor dictates  

Qualifications for the Outpatient Utilization Review Nurse Include:

  • 3+ years of Nursing experience
  • 1+ year of Utilization Review, Case Management, or Quality Assurance experience
  • Current RN licensure in Maryland
  • Associates degree in Nursing

Benefits for the Outpatient Utilization Review Nurse Includes:

  • Full Benefits Including: Health, Vision, Dental, PTO, Paid Holidays, 401k plan, Merit-Based Annual Salary Increases, Educational Stipend

 

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:

17566

Job Category:

Clinical & Life Sciences

Job Location:

Baltimore, MD  21230

Security Clearance:

No Clearance

Business Unit:

Piper Companies