Nurse Manager Utilization Management Job Listing at MedStar Medical Group in Clinton, MD (Job ID req42417)

Description

The primary responsibility of the Utilization Review (UR) and Denials Management Nurse is to utilize clinical expertise to interface with contracted third party vendor, VPMA or designated Physician Advisor, Providers, case management staff and other associates to facilitate timely review of the appropriateness and medical necessity of the treatments, services, procedures, and facilities provided to patients on a case-by-case basis and to support optimal hospital throughput and appropriate reimbursement for services rendered.
Education

• Graduation from an accredited School of Nursing required and
• Bachelor's degree in Nursing preferred

• 3-4 years experience in denial management required and
• knowledge of Utilization Review required

• RN - Registered Nurse - State Licensure and/or Compact State Licensure in the State of Maryland Upon Hire required

• Computer skills (Microsoft Office, Outlook, Internet, typing skills) required; able to adapt to required software programs which support Utilization Management functions. Familiarity with health care documentation systems. Creative problem-solving skills and a strong attention to detail and accuracy required. Possess knowledge of managed care insurance, governmental health programs, HMO's and their impact on hospital and post hospital care reimbursement. Must be able to work independently, anticipate and organize workflow, prioritize and follow through on responsibilities. Superior organization and time management skills required; able to skillfully manage a high-volume caseload and to respond effectively to rapidly changing priorities.