Case Manager, Utilization Review

Fort Washington, MD
Oct 15, 2020
Dec 05, 2020
Full Time
Adventist HealthCare Fort Washington Medical Center seeks to hire a Utilization Reviewer who will embrace our mission to extend God's care through the ministry of physical, mental and spiritual healing.

As a Case Manager:

•Responsible for reviewing medical records for clinical criteria, appropriate level of care and compliance with standards
•Assures compliance with standards; i.e. CAHO, COMAR, HIPAA, Federal and State Regulations
•Conducts pre-authorization as needed; performs concurrent and continued stay reviews.
•Prepares and submits medical record for appeal
•Assists the treatment team with information related to discharge planning and obtains authorization as needed
•Utilization Reviewer will submit clinical accurately to the Insurance Companies and in a timely manner. Communicate with the physicians and Case Managers. Assist with decrease of (length of stay) LOS.

Qualfications Include:
• Maryland Registered Nurse license
•Bachelor's degree in nursing required, Master's preferred
•Type 50WPM
•Time Management Efficient and accurate reviews
•CERNER knowledgeable a plus
•Interqual/MCG knowledge
•Knowledge of medication and medical terminology

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 hospitalization and outpatient procedures - at Adventist HealthCare facilities
• 100% Coverage for urgent care nationwide - zero 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 doing just that, making a difference.

Join the Adventist HealthCare team today! Apply now to be considered.

Work Schedule:

Discharge Planning and implementation.

Day Shift, M-F and rotating weekends

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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