Top 45 Clinical reviewer Jobs in Maryland

RN Team Lead Utilization Review
MedStar Health —Clinton, MD
- $89,065 - $162,801 a year
- Full-time
- Nursing
- RN License
- Inpatient
9d
Senior Clinical Nurse I, Emergency Dept
University of Maryland Medical System —Baltimore, MD
- Full-time
- CPR Certification
- Nursing
- RN License
12d
Referral Management (Non-Nurse) Reviewer
Zimmerman Associates, Inc. —Bethesda, MD
- $24.13 an hour
- Microsoft Excel
- Microsoft Outlook
- Mid-level
Patient Benefits Representative
Maryland Oncology —Eldersburg, MD
- $19.82 - $30.49 an hour
- Microsoft Excel
- HIPAA
- 3 years
Patient Benefits Rep Sr
Maryland Oncology —Silver Spring, MD
- $22.31 - $34.32 an hour
- HIPAA
- Mid-level
- Finance
3d
Sr. Clinical Research Associate
Emmes Group —Rockville, MD
- Full-time
- Bachelor's degree
- Organizational skills
- Experience equivalent to degree accepted
Customer Success Specialist
CooperSurgical —Rockville, MD
- Full-time
- Sales
- Marketing
- 5 years
- Health insurance
- Paid time off
Clinical Data Scientist, FDA (Sr.)
DRT Strategies, Inc. —Silver Spring, MD
- $100,000 - $135,000 a year
- Full-time
- 3 years
- Analysis skills
- Doctor of Philosophy
Licensed Practical Nurse Referral Reviewer
Zimmerman Associates, Inc. —Bethesda, MD
- $34.57 an hour
- Nursing
- Microsoft Excel
- Microsoft Outlook
Pharmacy Program Manager
Booz Allen Hamilton —Bethesda, MD
- $99,000 - $225,000 a year
- Full-time
- 7 years
- Doctoral degree
- Office
- Health insurance
- Flexible spending account
11d
Research Associate
University of Maryland, Baltimore —Baltimore, MD
- Online Application
- Mid-level
- Analysis skills
- University
Clinical Data Scientist, FDA (Jr.)
DRT Strategies, Inc. —Silver Spring, MD
- $90,000 - $120,000 a year
- Full-time
- 3 years
- Analysis skills
- Doctor of Philosophy
Instructor for Master of Science (MS) in Regulatory Science, Non-Tenure Track
University of Maryland, Baltimore —Baltimore, MD
- Weekends as needed
- Classroom
- Mid-level
- University
Clinic Director
IHMS USA, Inc —Frederick, MD
- $486,720 - $513,760 a year
- Full-time
- Spanish
- Medicine
- BLS Certification
- Health insurance
- Dental insurance
Quick Apply
Process Engineer MS&T -Drug Product
Precigen, Inc —Germantown, MD
- $90,000 - $110,000 a year
- Full-time
- Bachelor of Science
- Mid-level
- 3 years
Quick Apply
Medical Technologist (MLS)
Mercy Medical Center —Baltimore, MD
- $31.94 - $57.49 an hour
- Full-time
- Hospital
- 5 years
- Bachelor of Science
- 403(b) matching
- Paid holidays
3d
CardioMed Device Consultants- Principal Consultant
BDC Laboratories —Edgewater, MD
- Full-time
- Remote
- Public speaking
- Mentoring
- Senior level
Quick Apply
Senior Case Manager II
University of Maryland Medical System —Baltimore, MD
- Full-time
- Acute care
- Nursing
- RN License
Senior Case Manager I Med 2 Pod
University of Maryland Medical System —Baltimore, MD
- Full-time
- Acute care
- Nursing
- RN License
Senior Case Manager I Surgery Pod
University of Maryland Medical System —Baltimore, MD
- Full-time
- Acute care
- Nursing
- Surgery

I want to receive the latest job alert for clinical reviewer in maryland

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

clinical reviewer jobs near maryland

Senior Case Manager jobs in Baltimore, MD

Clinical Director jobs in Frederick, MD

Medical Technologist jobs in Baltimore, MD

Research Associate jobs in Baltimore, MD

Data Scientist jobs in Silver Spring, MD

Nurse jobs in Bethesda, MD

Instructor jobs in Baltimore, MD

Process Engineer jobs in Germantown, MD

Utilization Review Nurse jobs in Clinton, MD

Facilities Manager jobs in Illinois

Senior Case Manager jobs in Seattle, WA

Family Case Worker Trainee jobs in Maryland

Senior Case Manager jobs in West Palm Beach, FL

Senior Case Manager jobs in Salt Lake City, UT

Senior Case Manager jobs in South Burlington, VT

Property Manager jobs in Kalispell, MT

Clinical Research Coordinator jobs in San Jose, CA

Clinical Research Nurse jobs in New Jersey

Clinical Director jobs in Newnan, GA

Clinical Director jobs in Detroit, MI

RN Team Lead Utilization Review

MedStar Health -
Clinton, MD

Apply Now

Job Details

Full-time
$89,065 - $162,801 a year
9 days ago

Qualifications

Inpatient experience
RN License
Acute care facility experience
Bachelor's degree
Bachelor's degree in nursing

Full Job Description

About this Job:

In-patient Utilization Review RN experience highly preferred. Candidate must live in the DC/Baltimore region

General Summary of Position
Supervises the daily activities of the Utilization Review Team. Manages daily assignment ensuring all UM tasks are completed each day. Collaborates with the physician nurse case manager social worker and other members of the health care team to meet individualized patient outcomes. Assists the Director in managing the daily departmental operations with the goal of maintaining adequate staffing levels and efficient workflow. Acts as a resource and mentor to the Utilization Review staff.

Primary Duties and Responsibilities

Supervises daily activities of UM team. Monitors and arranges for adequate staffing to ensure appropriate Utilization Review coverage for units. Monitors daily workflow issues and addresses issues related to workflow in collaboration with the director as necessary.
Acts as a resource and mentor for UM Team. Oversees the orientation of new UR Coordinators by establishing the plan and monitoring progress in conjunction with other staff as necessary Serves as a resource to all staff in areas of utilization review/management. Educates members of health care team through in-services staff meetings orientation and formal educational offerings. Completes continuing education to maintain knowledge base.
Collaborates with and assists the nurse case manager and social worker to meet the patients' continuing health needs in a high-quality cost-effective manner by identifying patients in need of case management. Participates in planning rounds as needed to address and communicate issues related to acuity level of patient LOS insurance and discharge needs.
Collects quality improvement data in accordance with approved indicators. Monitors and audits staff UM reviews for completeness and compliance with standards. Recognizes potential problems and provides education to staff.
Utilizes research methods to collect tabulate and analyze data in collaboration with the case management team medical staff and hospital performance improvement initiatives. Assists CM Leadership in implementing strategies to correct or modify trends seen through data analysis and outcome monitoring.
Confers and collaborates routinely with the physician advisor and attending physicians to resolve problems regarding acuity and level of care.
Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
Identifies insurance information obtains authorization communicates with financial counseling and assigns appropriate length of stay for admission.
Implements strategies to avoid denials including potential denial notification to attending physician. Issues letter of non-coverage for Medicare or third-party payers according to policies and procedures. Communicates utilization plans to case management team. Evaluates concurrent and retrospective denials for appeal opportunities. Generates appeal letters based on knowledge of clinical severity and intensity.
Manages the department in the Director's absence. Keeps Director informed about issues related to staffing and problem areas. Keeps Director informed about issues related to quality risk patient/family issues and concerns allocation of resources and vendor/payer issues. Assists the Director in monitoring performance issues. Contributes to the performance evaluation process by giving feedback to the Director and helping create professional development plans for UR Coordinators.
Participates in multidisciplinary quality and service improvement teams.
Performs admission reviews and subsequent concurrent reviews to determine the necessity for acute care by application of accepted criteria based on age specific needs. Interacts with and assists third party payer reviewers to facilitate appropriate care and ensure payment of services. Performs concurrent and retrospective reviews telephonically as required. Completes all forms and documentation necessary to support appropriate utilization of resources.

Minimal Qualifications
Education

Bachelor's degree in Nursing required

Experience

3-4 years clinical experience in acute care setting required
2 years Case Management or Utilization Management experience preferred
1-2 years leadership experience preferred

Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure the District of Columbia or State of Maryland depending on work location required
CCM - Certified Case Manager preferred

This position has a hiring range of : USD $89,065.00 - USD $162,801.00 /Yr.

Apply Now

Refine Your Search

clinical reviewer jobs in maryland

RN Team Lead Utilization Review

Senior Clinical Nurse I, Emergency Dept

Referral Management (Non-Nurse) Reviewer

Patient Benefits Representative

Patient Benefits Rep Sr

Sr. Clinical Research Associate

Customer Success Specialist

Clinical Data Scientist, FDA (Sr.)

Licensed Practical Nurse Referral Reviewer

Pharmacy Program Manager

Research Associate

Clinical Data Scientist, FDA (Jr.)

Instructor for Master of Science (MS) in Regulatory Science, Non-Tenure Track

Clinic Director

Process Engineer MS&T -Drug Product

Medical Technologist (MLS)

CardioMed Device Consultants- Principal Consultant

Senior Case Manager II

Senior Case Manager I Med 2 Pod

Senior Case Manager I Surgery Pod

I want to receive the latest job alert for clinical reviewer in maryland

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected