Utilization Reviewer

Location
Gaithersburg, MD
Posted
Jan 09, 2021
Closes
Jan 24, 2021
Ref
R-012597
Function
Nurse
Industry
Healthcare
Hours
Full Time
Adventist Health Care seeks to hire an experienced Utilization Reviewer who will embrace our mission to extend God's care through the ministry of physical, mental and spiritual healing.

As the Utilization Manager, you will:
•Review medical records for clinical criteria, appropriate level of care and compliance with standards
•Conduct pre-authorization as needed; performs concurrent and continued stay reviews.
•Prepare and submits medical record for appeal
•Assist the treatment team with information related to discharge planning and obtains authorization as needed
•Demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients
•UR nurse to facilitate daily reviews, good time management and organized

Qualified candidates will possess:
•Bachelor's degree in nursing required, Master's preferred
. R.N.required
•College level reading, writing and math with strong verbal skills
•Basic PC skills (MS word, Excel and Access)
•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

Work Schedule:

M-F 8:30am-5pm

Tobacco and Drug 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 and drug use.

While some jurisdictions, including Maryland, permit the use of marijuana for medical purposes, marijuana continues to be classified as an illegal drug under the federal Controlled Substances Act. As a result, medical marijuana use will not be accepted as a valid explanation for a positive drug test result.

Adventist HealthCare will withdraw offers of employment to applicants who test positive for Cotinine (nicotine) and marijuana. Those testing positive 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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