Offer summary

Qualifications:

Licensure as a Registered Nurse or equivalent healthcare license in Maryland is required., Minimum of 12 months experience in case management or utilization management is necessary., Familiarity with nationally recognized care guidelines and criteria is essential., Strong communication skills for interfacing with various healthcare professionals are important..

Key responsibilities:

Provide utilization review and denials management for assigned patient case load.

Assess patient needs for outpatient or inpatient care using established guidelines.

Interface with case managers, medical teams, and payers to ensure appropriate care levels.

Collaborate with physician advisors and hospital staff to enhance patient care.

The University of Maryland Medical System (UMMS) was created in 1984 when the state-owned University Hospital became a private, nonprofit organization. It has evolved into a multi-hospital system with academic, community and specialty service missions reaching every part of the state and beyond. UMMS is a national and regional referral center for trauma, cancer care, neurocare, cardiac care, women's and children's health and physical rehabilitation. It also has one of the world's largest kidney transplant programs, as well as scores of other programs that improve the physical and mental health of thousands of people daily. The hospitals and health systems that comprise UMMS are: University of Maryland Medical Center University of Maryland Medical Center Midtown Campus UM Rehabilitation and Orthopaedic Institute UM Baltimore Washington Medical Center UM Capital Region Health UM Charles Regional Medical Center UM St. Joseph Medical Center UM Upper Chesapeake Health UM Shore Regional Health Mt. Washington Pediatric Hospital UM Community Medical Group

Job description

Company Description

UTILIZATION MANAGEMENT SPECIALIST II

Renowned as the academic flagship of the University of Maryland Medical System, our Magnet®-designated facility is a nationally recognized, academic medical center with opportunities across the continuum of care. Come join UMMC and discover the atmosphere where talents and ideas come together to enhance patient care and advance the science of nursing. Located in downtown Baltimore near the Inner Harbor and Camden Yards, you won’t find a more vibrant place to work!

Job Description

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.

Qualifications

Education and Experience

Licensure as a Registered Nurse or other equivalent health care license in the state of Maryland, or eligible to practice due to Compact state agreements outlined through the MD Board of Nursing, is required
Minimum of 12 months experience in case management or utilization management required