Top 40 Utilization review nurse Jobs in Olney, Md

Utilization Reviewer
University of Maryland Medical System —Largo, MD
- $40.61 - $60.96 an hour
- Full-time
- Nursing
- RN License
- Hospital
Medical Review Nurse- Medicare
Peraton —Linthicum, MD
- $66,000 - $106,000 a year
- Remote
- Nursing
- RN License
- Research
- Health savings account
- Paid holidays
12d
Clinical Reviewer DC
Comagine Health —Washington, DC
- $93,000 - $104,000 a year
- Full-time
- Hybrid work
- RN License
- Writing skills
- Mid-level
- Paid parental leave
- Health insurance
Quick Apply
Utilization Review Coordinator
Psychiatric Institute of Washington —Washington, DC
- $33.60 - $50.40 an hour
- PRN
- Psychiatry
- Pass drug screening
- Adults
- Health insurance
- Dental insurance
Nurse CARE Manager, Wellness Center & Case Management
Marriott International, Inc —Bethesda, MD
- $84,000 - $147,500 a year
- Full-time
- CPR Certification
- Nursing
- Medication administration
- Commuter assistance
- Paid parental leave
Contingent UR/LTSS Registered Nurse
iMPROve Health (MICHIGAN PEER REVIEW ORGANIZATION) —Washington, DC
- $36 - $42 an hour
- Weekends as needed
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
Utilization Management Reviewer
Amerihealth Caritas —Washington, DC
- $41.35 - $56.39 an hour
- Overtime
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Paid holidays
- Disability insurance
Medical Review Nurse III
RELI GROUP INC —Windsor Mill, MD
- $80,000 - $95,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
Case Manager Registered Nurse
Suburban Hospital —Bethesda, MD
- Full-time
- CPR Certification
- Nursing
- Surgery
- Health insurance
- Opportunities for advancement
10d
Transition of Care RN
CINQCARE —Washington, DC
- $76,794 - $94,000 a year
- Full-time
- Remote
- Nursing
- Skilled nursing facility
- RN License
- Mileage reimbursement
- Commuter assistance
Quick Apply
Clinical Review Specialist
Healthcare Legal Solutions LLC —Washington, DC
- $45 - $50 an hour
- Nursing
- RN License
- Certified Nurse Practitioner
Quick Apply
Behavioral Health Utilization Management Reviewer
Amerihealth Caritas —Washington, DC
- $77,700 - $105,900 a year
- Weekends as needed
- Hybrid work
- LMFT
- Nursing
- Microsoft Excel
- Paid holidays
- Health insurance
12d
Travel RN - Case Management/Utilization Review - Case Management
American Traveler —Silver Spring, MD
- $2,917 a week
- 8 hour shift
- Acute care
- Nursing
- RN License
Quick Apply
Case Manager II
Children's National Hospital —Washington, DC
- $87,172.80 - $145,267.20 a year
- Weekends as needed
- Nursing
- RN License
- Customer service
- Commuter assistance
- AD&D insurance
Medical Review RN
LifeHealth LLC —Washington, DC
- $45 an hour
- Part-time
- 18 years or older
- CPR Certification
- Nursing
Quick Apply
Special Operations Nurse Case Manager / Case Manager Part-Time (National Capital Region)
KBR —Washington, DC
- $49.31 - $54.64 an hour
- Part-time
- Nursing
- RN License
- Military
- AD&D insurance
- Disability insurance
Special Operations Case / Nurse Case Manager Part-Time (National Capitol Region)
KBR —Alexandria, VA
- $49.31 - $54.64 an hour
- Part-time
- Nursing
- RN License
- Military
- AD&D insurance
- Disability insurance
Nurse Case Manager
Battelle —Arlington, VA
- Full-time
- Hybrid work
- Nursing
- RN License
- BLS Certification
- Wellness program
- Health insurance
ADON - RN
Charlestown by Erickson Senior Living —Catonsville, MD
- $115,000 - $130,000 a year
- 18 years or older
- Nursing
- RN License
- Health insurance
- Dental insurance
Manager, Clinical Documentation Integrity
Adventist HealthCare —Gaithersburg, MD
- $105,664.42 - $158,496.00 a year
- Full-time
- Medicine
- Anatomy knowledge
- RN License
- Free parking
- AD&D insurance
Quick Apply

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Utilization Reviewer

University of Maryland Medical System -
Largo, MD

Apply Now

Job Details

Full-time
$40.61 - $60.96 an hour

Qualifications

Collaborate with healthcare professionals
RN License
Bachelor's degree
Bachelor's degree in nursing
Computer skills
Healthcare software applications
Team building

Full Job Description

Job Requirements

Located in Largo in the heart of Prince George’s County, our state-of-the-art regional medical center (University of Maryland Capital Region Medical Center) will provide improved access to primary and ambulatory care services and serve as a tertiary care center for critically ill patients. In addition, our new space will allow us to expand our offerings as a community partner to help improve the health status of Prince George’s County residents.

Position Summary:

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.

Primary Responsibilities:

Performs timely and accurate utilization review for all patient populations, using nationally recognized care guidelines/criteria relevant to the payer.

Communicates with clinical care coordinators, 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.

Conducts HINN discussions/Observation Education.

Collaborates with Clinical Care Coordinators concerning Avoidable Days Collection.

Ensures Regulatory Compliance related to Utilization Management conditions of participation.

Assures appropriate reimbursement and stewardship of organizational and patient resources.

Pursues and reports opportunities to improve reimbursement.

Collaborates with admitting specialists regarding authorization policies and procedures of third-party payers. Remains current on clinical practice and protocols impacting clinical reimbursement.

Work Experience

Education Bachelors in Nursing required.

Licensure as a Registered Nurse in the state of Maryland, or eligible to practice due to Compact state agreements outlined through the MD Board of Nursing, is required

One year of experience in case management or utilization management with knowledge of payer mechanisms and utilization management is preferred.

Two years’ experience in acute care and four years clinical healthcare experience preferred.

Certified Professional Utilization Reviewer (CPUR) preferred.

Additional experience in home health, ambulatory care, and/or occupational health is preferred.

Knowledge, Skills and Abilities

1. Highly effective verbal and written skills are required.

2. Strong communication skills, self-confidence and experience in working with physicians are required.

3. Excellent analytical and team building skills, as well as the ability to prioritize and work independently are required.

4. The ability to work collaboratively with other disciplines is required.

5. Ability to work with Hospital/ Utilization Management and related software programs is required.

6. Knowledge of utilization management is preferred.

Benefits

All your information will be kept confidential according to EEO guidelines.

Compensation:

Pay Range: $40.61-$60.96
Other Compensation (if applicable):
Review the 2024-2025 UMMS Benefits Guide

Apply Now

Refine Your Search

utilization review nurse jobs in olney, md

Utilization Reviewer

Medical Review Nurse- Medicare

Clinical Reviewer DC

Utilization Review Coordinator

Nurse CARE Manager, Wellness Center & Case Management

Contingent UR/LTSS Registered Nurse

Utilization Management Reviewer

Medical Review Nurse III

Case Manager Registered Nurse

Transition of Care RN

Clinical Review Specialist

Behavioral Health Utilization Management Reviewer

Travel RN - Case Management/Utilization Review - Case Management

Case Manager II

Medical Review RN

Special Operations Nurse Case Manager / Case Manager Part-Time (National Capital Region)

Special Operations Case / Nurse Case Manager Part-Time (National Capitol Region)

Nurse Case Manager

ADON - RN

Manager, Clinical Documentation Integrity

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