Utilization Review Technician jobs in Maryland
Utilization Review Technician conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Technician reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Technician consults with nurses and physicians as needed. Position is non-RN. May require an associate degree or its equivalent. Typically reports to a supervisor. May require Registered Health Information Technician (RHIT). The Utilization Review Technician gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Utilization Review Technician typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Recently Added Utilization Review Technician jobs
- Utilization Review - 630
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Baltimore, MD
FULL_TIME
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Utilization Review - 630As NeededDay 8 Hour Shifts (8:30 am-5:00 pm)0Req# 43127
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
GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law. - 1 Month Ago
- LifeBridge Health
-
Randallstown, MD
FULL_TIME
- Summary Position Summary: Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to decrease avoidable ...
- 21 Days Ago
- Johns Hopkins Medicine
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Hanover, MD
FULL_TIME
- Who you are: As a Utilization Review Registered Nurse for Johns Hopkins Health Plans, you have the opportunity to use your clinical, managed care, utilization review, and verbal/written communication ...
- Just Posted
- GBMC HealthCare
-
Baltimore, MD
OTHER
- 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 f...
- 1 Month Ago
- Korak Healthsource Group
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Glen Burnie, MD
FULL_TIME
- Additional InformationAll your information will be kept confidential according to EEO guidelines.
- 1 Month Ago
- University of Maryland Medical System
-
Baltimore, MD
FULL_TIME
- Job DescriptionUnder general supervision, provides utilization review and denials management for an assigned patient case load. This role utilizes nationally recognized care guidelines/criteria to ass...
- 1 Month Ago
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- ASARCO LLC
-
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- Koniag Government Services
-
Arlington, VA
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- 4/23/2024 12:00:00 AM