Utilization Review - Baltimore, United States - Greater Baltimore Medical Center

Description

Utilization Review - Non Exempt

JOB DESCRIPTION SUMMARY:

Under general supervision, utilize clinical knowledge and critical thinking skills to provide oversight of appropriate admission status and utilization of hospital resources facilitating quality, cost-effective patient outcomes.#

Works collaboratively with interdisciplinary staff internal and external to the organization ensuring maximum reimbursement for the hospital through the utilization review process.

Active participation and attendance in daily multidisciplinary rounds.

Responsible for analyzing clinical information and performing timely concurrent and retrospective reviews using InterQual screening software to identify appropriate medical necessity, length of stay, and level of care based upon evidence based clinical guidelines.

Education Bachelor of Science in Nursing (BSN) OR Advanced Practitioner licensure # Experience Seven (7) years diversified, progressive experience in acute care and/or other settings within the continuum required.

Two (2) years of Case Management which includes Utilization Review, Discharge Planning and working with Re-Admission Initiatives preferred.

# Knowledge, Skills and Abilities Broad knowledge of medical treatment practices Knowledge of healthcare regulatory agency standards for health care organizations.

Ability to operate independently and to balance multiple priorities.

Strong interpersonal, and influencing skills necessary to interact effectively with physicians, payers, regulatory agencies, staff, and other health professionals Knowledge of InterQual and/or Milliman criteria # Skill in using computer software programs Advanced skill in oral and written communication Advanced skill in critical thinking Ability to resolve complex problems Ability to remain calm under pressure and intense time constraints Ability to assess discharge needs for patients Licensures, Certifications Current state of Maryland Registered Nurse, Physician Assistant, or Nurse Practitioner license Certification in Utilization Management and/or Care Management highly desired.

Physical Requirements Ability to sit, stand, stoop, and bend.

Working Conditions Primarily in an office environment, evaluating electronic medical records and performing electronic documentation and communication 70% of time.

# Remainder of time working with interdisciplinary staff, Conditions of Employment # Maintain current licensure and certification


JOB DESCRIPTION SUMMARY:

Under general supervision, utilize clinical knowledge and critical thinking skills to provide oversight of appropriate admission status and utilization of hospital resources facilitating quality, cost-effective patient outcomes.

Works collaboratively with interdisciplinary staff internal and external to the organization ensuring maximum reimbursement for the hospital through the utilization review process.

Active participation and attendance in daily multidisciplinary rounds.

Responsible for analyzing clinical information and performing timely concurrent and retrospective reviews using InterQual screening software to identify appropriate medical necessity, length of stay, and level of care based upon evidence based clinical guidelines.

Education

Bachelor of Science in Nursing (BSN) OR Advanced Practitioner licensure

Experience

Seven (7) years diversified, progressive experience in acute care and/or other settings within the continuum required.

Two (2) years of Case Management which includes Utilization Review, Discharge Planning and working with Re-Admission Initiatives preferred.

Knowledge, Skills and Abilities

• Broad knowledge of medical treatment practices
• Knowledge of healthcare regulatory agency standards for health care organizations.
• Ability to operate independently and to balance multiple priorities.
• Strong interpersonal, and influencing skills necessary to interact effectively with physicians, payers, regulatory agencies, staff, and other health professionals
• Knowledge of InterQual and/or Milliman criteria
• Skill in using computer software programs
• Advanced skill in oral and written communication
• Advanced skill in critical thinking
• Ability to resolve complex problems
• Ability to remain calm under pressure and intense time constraints
• Ability to assess discharge needs for patients

Licensures, Certifications

• Current state of Maryland Registered Nurse, Physician Assistant, or Nurse Practitioner license
• Certification in Utilization Management and/or Care Management highly desired.

Physical Requirements

• Ability to sit, stand, stoop, and bend.

Working Conditions

• Primarily in an office environment, evaluating electronic medical records and performing electronic documentation and communication 70% of time. Remainder of time working with interdisciplinary staff,

Conditions of Employment

• Maintain current licensure and certification