Top 4 Utilization review nurse Jobs in Hagerstown, Md

Case Manager-RN - Case Management - Day
Wellspan Health —Chambersburg, PA
- Part-time
- Nursing
- RN License
- Hospital

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Care Manager RN Outpatient
Meritus Medical Center Inc —Hagerstown, MD
Active Registered Nurse license in Maryland or qualifying Nurse Licensure Compact (NLC) multi-state license. Coach and educate patients on disease management,…
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Case Manager-RN - Case Management - Day
Wellspan Health —Chambersburg, PA
Completes case management patient assessment, identifies needs, develops a discharge plan, and coordinates discharge needs (DME, Home Health, IV antibiotics,…

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Utilization Review Specialist - Autism
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Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
Case Manager (RN) - Full-Time
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Case Manager-RN - Case Management - Day

Wellspan Health -
Chambersburg, PA

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Job Details

Part-time

Qualifications

BLS Certification
Acute care experience
Associate's degree

Full Job Description

General Summary

Performs a variety of duties and applies utilization and case management techniques to determine the most efficient use of resources to facilitate a patient's progression of care and the provision of appropriate, cost effective and quality health care. Works in a team model with social work in assigned patient care areas to address patient discharge needs. Provides leadership in the integration of utilization and case management principles.

Duties and Responsibilities

Reviews assigned patients for medical necessity, utilization management, and appropriateness of setting for continued hospitalization.
Initiates problem-solving techniques to prevent over and/or under utilization.
Facilitates and coordinates the progression of patient care to optimize throughput and the utilization of resources to support continuous quality and cost of care efforts.
Liaisons between utilization management team, third party payers, and the treatment team regarding the identified treatment plan in accordance with contractual guidelines and System policy.
Assists the patient care team with the identification and coordination of alternative treatment settings to provide appropriate care, maintain quality of care, and reduce cost.
Identifies conditions which require case management across the care continuum. Collaborates with members of the patient care team to identify interdisciplinary needs
Collaborates with care management across the system to effectively transition patient care and support value-based care initiatives.
Completes case management patient assessment, identifies needs, develops a discharge plan, and coordinates discharge needs (DME, Home Health, IV antibiotics, etc.) in collaboration with patients, families, and care team.
Assists with the collection and analysis of utilization patterns, length of stay, readmissions, avoidable days, and denied cases.
Brings known or suspected problems of under-, over-, or inappropriate utilization of resources to the attention of the appropriate manager(s).
Demonstrates a commitment to patient, visitor, and staff by complying with all applicable safety regulations, learning the impact of medical errors and methodology that will lead to reduction of errors; reporting actual and potential errors, as well as hazardous conditions; identifying opportunities to standardize processes and “error proof” systems that will lead to increased safety; and participating in safety education programs and root cause analyses as required.
Prepares and maintains appropriate documentation as required.
Maintains established policies and procedures, objectives, quality assessment and safety standards.
Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
Prepares and presents utilization data analysis as required.
Participates in the development and delivery of educational information and process improvements related to job accountabilities and case management principles.
Attends meetings as required.
Performs other related duties as identified.
WellSpan Health has adopted and implemented a compliance program to support WellSpan's values and standards for professionalism, integrity, and ethics. Expected to support and meet the values and standards of the organization and the performance expectations of the job, the department, and the compliance program.
WellSpan Health has adopted and implemented a privacy program to safeguard the patient information and the business and operational information of the organization. Expected to support and meet the values and standards of the organization to safeguard patient and business/operational information.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

Qualifications

Minimum Education:

Associates Degree Required
Bachelors Degree Preferred

Work Experience:

2 years Recent acute care experience Required
Field of Experience in Utilization Management, Case Management, or Clinical Nursing Specialty. Preferred

Licenses:

Licensed Registered Nurse Upon Hire Required or
Registered Nurse Multi State License Upon Hire Required and
Basic Life Support Upon Hire Required
Certified in Case Management Preferred

Knowledge, Skills, and Abilities:

Excellent interpersonal and communication skills.
Basic computer skills.
Desire and ability to work in a supportive and collaborative team environment.

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utilization review nurse jobs in hagerstown, md

Case Manager-RN - Case Management - Day

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