Top 292 Utilization management Jobs in Baltimore, Md

Utilization Management Specialist II
University of Maryland Medical System —Baltimore, MD
- Full-time
- RN License
- Mid-level
- Analysis skills
Case Manager
Mercy Medical Center —Baltimore, MD
- $36.92 - $66.46 an hour
- Full-time
- Nursing
- RN License
- Hospital
- 403(b) matching
- Paid holidays
2d
Care Manager (Remote)
CareFirst BlueCross BlueShield —Baltimore, MD
- $72,360 - $143,715 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- RN License
- 401(k)
Quick Apply
10d
Denials Management Nurse
UR SOLUTIONS —Towson, MD
- Day shift
- Nursing
- Microsoft Outlook
- Bachelor of Science
Insurance Follow Up Specialist
UR SOLUTIONS —Towson, MD
- Full-time
- HIPAA
- Mid-level
- Office
Case Management Technician, PRN
University of Maryland Medical System —Towson, MD
- PRN
- Hospital
- High school diploma or GED
- Home Health
2d
Pharmacy Benefit Coordinator
Maryland Care Management Inc —Linthicum, MD
- $67,000 - $72,000 a year
- Full-time
- Remote
- Writing skills
- Mid-level
- High school diploma or GED
- Disability insurance
- Health insurance
Courier Union
University of Maryland Medical System —Baltimore, MD
- Part-time
- CPR Certification
- Hospital
- BLS Certification
5d
Utilization Management Supervisor (Hybrid)
CareFirst BlueCross BlueShield —Baltimore, MD
- $82,800 - $170,775 a year
- Full-time
- Nursing
- RN License
- Mid-level
- 401(k)
Quick Apply
5d
Associate Administrator
Johns Hopkins University —Baltimore, MD
- $98,200 - $171,900 a year
- Full-time
- Background check
- Addiction Medicine
- Internal Medicine
Senior Consultant - Clinical Documentation Specialist
Deloitte —Baltimore, MD
- $110,700 - $218,300 a year
- Full-time
- Microsoft Word
- Nursing
- RN License
Utilization Management Nurse
Luminis Health —Annapolis, MD
- $34 - $55 an hour
- Full-time
- Nursing
- RN License
- Bachelor of Science
- AD&D insurance
- Paid holidays
Assistant Administrator - Clinical
Johns Hopkins University —Baltimore, MD
- $85,500 - $149,800 a year
- Full-time
- Hybrid work
- Background check
- Surgery
- Office
4d
Telephonic Case Manager I
CorVel Corporation —Nottingham, MD
- $63,739 - $95,264 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
Quick Apply
Revenue Cycle Coordinator I- Collections
Johns Hopkins Health System —Baltimore, MD
- Full-time
- Hospital
- Mid-level
- High school diploma or GED
Lab Supervisor
Quest Diagnostics —Baltimore, MD
- $76,400 - $107,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- 5 years
- Employee stock purchase plan
- Disability insurance
Quick Apply
5d
Utilization Management Director - Inpatient (Hybrid)
CareFirst BlueCross BlueShield —Baltimore, MD
- $135,040 - $250,668 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
- 401(k)
Quick Apply
Associate Administrator - Clinical
Johns Hopkins University —Baltimore, MD
- $98,200 - $171,900 a year
- Full-time
- Background check
- Office
- Finance
Case Manager I
University of Maryland Medical System —Baltimore, MD
- Weekends as needed
- Acute care
- Nursing
- RN License
Care Management Tech
University of Maryland Medical System —Woodlawn, MD
- Full-time
- Hospital
- High school diploma or GED
- Home Health
2d

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utilization management jobs near baltimore, md

Utilization Management Specialist II

University of Maryland Medical System -
Baltimore, MD

Apply Now

Job Details

Full-time

Qualifications

Collaborate with healthcare professionals
Utilization management
Computer skills
Healthcare software applications
Team building

Full Job Description

Job Requirements

Under general supervision, provides utilization review and denials management for an assigned patient case load. This role utilizes nationally recognized care guidelines/criteria to assess the patient’s need for outpatient or inpatient care as well as the appropriate level of care. The role requires interfacing with the case managers, medical team, other hospital staff, physician advisors and payers.

Responsibilities and Tasks

Performs timely and accurate utilization review for all patient populations, using nationally recognized care guidelines/criteria relevant to the payer.
Communicates with case manager, physician advisor, medical team and payors as needed regarding reviews and pended/denied days and interventions.
Supports concurrent appeals process through proactive identification of pended/denied days. Implements the concurrent appeals process with appropriate referrals and documentation.
Ensures appropriate Level of Care and patient status for each patient (Observation, Extended Recovery, Administrative, Inpatient, Critical Care, Intermediate Care, and Med-Surg)
Reviews tests, procedures and consultations for appropriate utilization of resources in a timely manner
HINN discussions/Observation Education
Assists Case Manager in Avoidable Days Collection
Ownership of Regulatory Compliance related to Utilization Management conditions of participation
Assures appropriate reimbursement and stewardship of organizational and patient resources.
Actively reports opportunities to improve reimbursement and responds to relevant data
Collaborates with admitting specialists regarding authorization policies and procedures of third party payers.
Remains current on clinical practice and protocols impacting clinical reimbursement
Participates in department improvement initiatives
Serves to orient and educate Utilization Manager 1s
Provides oversight and education to utilization management interns placed in the practice area

Work Experience

Education and Experience

Licensure as a Registered Nurse or other equivalent health care license in the state of Maryland, or eligible to practice due to Compact state agreements outlined through the MD Board of Nursing, is required
Minimum of 12 months experience in case management or utilization management required

Knowledge, Skills and Abilities

Knowledge of utilization management is required.
Highly effective verbal and written skills are required.
Strong communication skills, self-confidence and experience in working with physicians are required.
Excellent analytical and team building skills, as well as the ability to prioritize and work independently are required.
The ability to work collaboratively with other disciplines is required.
Ability to work with Hospital/ Utilization Management and related software programs is required.

Patient Safety

Ensures patient safety in the performance of job functions and through participation in hospital, department or unit patient safety initiatives.

Takes action to correct observed risks to patient safety.
Reports adverse events and near misses to appropriate management authority.
Identifies possible risks in processes, procedures, devices and communicates the same to those in charge.

Apply Now

Refine Your Search

utilization management jobs in baltimore, md

Utilization Management Specialist II

Case Manager

Care Manager (Remote)

Denials Management Nurse

Insurance Follow Up Specialist

Case Management Technician, PRN

Pharmacy Benefit Coordinator

Courier Union

Utilization Management Supervisor (Hybrid)

Associate Administrator

Senior Consultant - Clinical Documentation Specialist

Utilization Management Nurse

Assistant Administrator - Clinical

Telephonic Case Manager I

Revenue Cycle Coordinator I- Collections

Lab Supervisor

Utilization Management Director - Inpatient (Hybrid)

Associate Administrator - Clinical

Case Manager I

Care Management Tech

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