RN-Utilization Review
: Job Details :

Details

• Department: Utilization Management
• Schedule: On-site, Monday-Friday, start time between 7am-9am, 8 hours shift, with occasional weekends
• Hospital: Ascension St. Agnes
• Location: Baltimore, MD
• Salary: $35.84-$53.76

Actual compensation offered will vary based on factors including applicable licenses, certifications, education, experience, location, qualifications and comparison with associates in similar roles

2 years Utilization Review experience preferred.

Effective communication with healthcare providers, patients, and insurance companies to explain utilization review decisions.

Familiarity with electronic health records and utilization management software.

Benefits

Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance programs (EAP) Parental leave & adoption assistance Tuition reimbursement Ways to give back to your community

Benefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, performance and salary range at the time of the offer.

Responsibilities

Provide health care services regarding admissions, case management, discharge planning and utilization review.

Responsibilities:

• Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provide case management and/or consultation for complex cases.
• Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
• Assess and coordinate discharge planning needs with healthcare team members.
• May prepare statistical analysis and utilization review reports as necessary.
• Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.

Requirements

Licensure / Certification / Registration:

• Registered Nurse credentialed from the Maryland Board of Nursing obtained prior to hire date or job transfer date required.

Education:

• Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.

Additional Preferences

Responsibilities:

• Strong understanding of medical conditions, treatment options, and clinical guidelines.
• Reviews admissions and service requests within assigned unit for prospective, concurrent andretrospective medical necessity and/or compliance with reimbursement policy criteria.
• Assists departmental staff with issues related to coding, medical records/documentation,pre-certification, reimbursement and claim denials/appeals.
• Reviewing and responding to appeals from providers regarding denied authorization requests.

Why Join Our Team

Ascension Saint Agnes in Baltimore, Maryland operates a full-service, 254-bed teaching hospital, the Ascension Saint Agnes Medical Group, Ascension Saint Agnes Imaging Center and Ascension Saint Agnes Foundation. As an associate, you will be a part of a team that is committed to providing a place of respect and inclusion for all associates, as well as a rich learning environment with countless opportunities for career growth and professional development.

Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.

Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.

Equal Employment Opportunity Employer

Ascension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.

For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.

As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension.

Pay Non-Discrimination Notice

Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.

This Ministry does not participate in E-Verify and therefore cannot employ STEM OPT candidates.