Utilization Reviewer (RN)
What You Will Do:Utilization Reviewer (RN)Full-time - Rotating Shift UM Capital Region Health - Largo, Maryland UM Capital Region Health is recruiting an experienced Utilization Reviewer to join our award-winning team. Are you ready to get back to your calling of patient care? To be respected by your peers and have your voice heard by your physicians? To regain your work-life balance and have time and resources to further your education? To be part of a cohesive team that gets to work on every cardiac case and be there with your patients from admission to discharge? If you are ready to get back to the core mission of nursing and patient care, UM Capital Region Health wants to talk to you! Under general supervision, provides utilization review and denials management for an assigned patient caseload. 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.UM Capital Region Health is about to changeUP everything with the construction of UM Capital Region Medical Center, a new, state-of-the-art hospital facility in Largo, MD. On track to open in April of 2021, our new Medical Center will feature a dedicated Intensive Care Unit, which will be a center of excellence in heart care in Prince George's County.What we offer:Opportunity to work with a small, cohesive team of experienced professionals.A comprehensive benefits package including health, vision and dental coverage including prescription drug coverage.Great Work Life Balance: You'll accrue paid annual leave; we offer dependent care reimbursement, short/long term disability and an employee assistant program.Competitive salaryEducational Assistance: We support your continuing education and career advancement by offering tuition reimbursement. What You Need to Be Successful: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.Bachelors in Nursing 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.BLS certification from American Heart Association for Healthcare Providers. We are an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.