Utilization Review Registered Nurse

Rockville, MD
Aug 26, 2020
Sep 24, 2020
Full Time
Adventist HealthCare seeks to hire an experienced Utilization Review Registered Nurse who will embrace our mission to extend God's care through the ministry of physical, mental and spiritual healing.

The Utilization Review Registered Nurse works in a fast-paced environment drafting materials; writing newsletter articles, blogs and social media posts; designing materials following brand standards; working with reporters on stories, working with vendors and supporting the overall PR/Marketing team at the hospital and AHC. The Public Relations Marketing Coordinator works to support all departments in projects related to community events through pre-event coordination and day-of event support.

As a Utilization Review Registered Nurse, you will:
• Build relationships and coordinate with payer sources to assure proper reimbursement for hospital provided services, promote costs attentive care via focus on resource management within the plan of care.
• Promote quality care through the efficient and effective use of the Hospital's resources by exerting special efforts in reviewing medical necessity of admission, length of stay, promptness of service, use of consultations and implementation of effective discharge planning in a timely manner.
• Maintain current literature on preadmission screening criteria and policies and procedures of insurance carriers.
• Collaborate with payors, care providers and review organizations to ensure proper utilization of patient care resources.
• Review patient records according to payor contractual agreements or as needed.
• Provide education support and training for clinical staff regarding appropriate clinical documentation as well as guidelines for the Medicare 2 Midnight rule.
• Perform real-time chart reviews regarding compliance and physician documentation
• Communicate with third party payers, third party payer initial denials
• Review admission service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria.
• Interact with Physicians and Care Management staff, Admitting and Accounts Receivable staff on a daily basis and assists with trouble shooting issues on an ongoing basis.
• Network with insurers to resolve those denial issues that can be managed successfully without appeal.

Qualifications include:
• Bachelor's Degree in Nursing
• Registered Nurse license in the State of Maryland
• Typing 35-40 wpm, very strong computer skills
• Minimum of 5 years recent nursing experience with a broad clinical nursing background
• 2-5 years acute Case Management experience
• Case Management Certification—to achieve within 2-5 yrs
• Ability to handle a multi task environment

At Adventist HealthCare our job is to care for you. We do this by offering:
• Work life balance through non rotating shifts
• Recognition and rewards for professional expertise
• Free Employee parking
• Competitive comprehensive benefit plans offered (including health, disability, PTO and 403B
retirement plan with matching and 3 year vesting)
• 100% Coverage for inpatient care - at Adventist HealthCare facilities
• 100% Coverage for urgent care nationwide - after copay

As a faith-based organization, with over a century of caring for the communities in the Maryland area, Adventist HealthCare has earned a reputation for high-quality, compassionate care. Adventist HealthCare was the first and is the largest healthcare provider in Montgomery County.

If you want to make a difference in someone's life every day, consider a position with a team of professionals who are

Work Schedule:

Three positions available:

#1: Full-time; 36 hours per week, three 12-hour shifts; 8:00 am - 8:30 pm (flexible) - Shady Grove Medical Center

#2: Full-time; 40 hours per week float, 8:30 am - 5:00 pm - Shady Grove Medical Center & White Oak Medical Center

#3: Full-time; 40 hours per week, four 10-hour shifts, 10:00 am - 8:00 pm - Shady Grove Medical Center Emergency Deprartment

Tobacco Statement

Tobacco use is a well-recognized preventable cause of death in the United States and an important public health issue. In order to promote and maintain a healthy work environment, Adventist HealthCare will not hire applicants for employment who either state that they are nicotine users or who test positive for nicotine use.

Adventist HealthCare will withdraw offers of employment to applicants who test positive for Cotinine (nicotine). Those testing positive for cotinine are given the opportunity to re-apply in 90 days, if they can truthfully attest that they have not used any nicotine products in the past ninety (90) days and successfully pass follow-up testing.

Equal Employment Opportunity

Adventist HealthCare is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.

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