Summary

Position Summary: Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of payment.

Essential Functions -

• Chart Review Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource consumption.
• Denial Management Monitors and identifies patterns or trends in utilization management.
• Care Coordination Coordinates with the Care Manager to achieve optimal and efficient patient outcomes, while decreasing length of stay and avoid delays and denied days.

Qualifications/Requirements -

Education/Knowledge:Basic professional knowledge; equivalent to a Bachelor's degree; working knowledge of theory and practice within a specialized field Education/Knowledge:

Education Discipline:

• Minimal degree requirement: Bachelor of Science in Nursing. (BSN's from CCNE accredited schools)

Certification or Licenses:

• Required Maryland Registered Nurse License

Experience:

• Medical terminology (Frequently)
• Nursing Process skills based on MD Nurse
• Practice Act (Frequently)
• Critical thinking skills (Frequently) Midas (Frequently)
• Healthstream (Occasionally)
• Utiization Review Criteria (Frequently)
• Microsoft Office Suite (Frequently)
• Basic computer skills (Frequently)
• Cerner (Frequently)
• Standard Office Equipment (Frequently)

Additional Comments Work from home will be 95% or greater. Training/remediation may be onsite with occasional onsite meetings

Additional Information