Utilization Management Nurse - Emergency Department

Success Profile

• Organized
• Goal-oriented
• Analytical
• Quick-thinking
• Motivational
• Team player

Culture

When you become a Luminary, you’ll be part of a team that embraces your authentic self, supports your wellbeing, and empowers you to help build a more inclusive world.

Utilization Management Nurse - Emergency Department

Additional Information

Anne Arundel Medical Center; Part Time (24 hours/week) - Day shift (8a-4:30p, rotate weekends/holidays). ONSITE role.

Position Objective

Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of payment.

Essential Job Duties

• Chart Review: Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource utilization; enters clinical review in EPIC; maintains close communication with external reviews, care coordinators, and providers; reconciles and records days authorized in EPIC
• Denial Management: Monitors and identifies patterns or trends in utilization management; monitors potential and actual denials and collaborates with care coordinator for any follow up necessary; documents actions taken to avoid denial; assists Care Coordinator in communicating with the patient denied hospital days with work toward resolution and discharge.
• Care Coordination: Collaborates with the Care Coordinator to achieve optimal and efficient patient outcomes while decreasing length of stay, avoidable delays and denied days; utilizes Physician Advisor and administrative personnel for unresolved issues; identifies opportunities for expedited appeals and collaborates with the care coordinator and Physician Advisor to resolve payer issues.
• Process improvement initiatives: Participates in nursing unit and department clinical outcome projects as well as process improvement initiatives of care management.

Education/Experience Requirements

• Bachelor’s of Science in Nursing or Associate’s degree in Nursing with equivalent experience. BSN must be achieved within 5 years of start date in the role.
• Three years of clinical nursing in an acute care hospital setting.

Licensure/Certification

• Current RN license from Maryland Board of Nursing.

Working Conditions, Equipment, Physical Demands

• The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

Luminis Health Benefits Overview

• Medical, Dental, and Vision Insurance
• Retirement Plan (with employer match for employees who work more than 1000 hours in a calendar year)
• Paid Time Off
• Tuition Assistance Benefits
• Employee Referral Bonus Program
• Paid Holidays, Disability, and Life/AD&D for full-time employees
• Wellness Programs
• Employee Assistance Programs and more

Benefits

• Medical & Wellness
• Adoption Assistance
• Life & Survivor Benefits
• Income Protection
• Pet Insurance
• Tuition Assistance

Location

Annapolis, MD

About the City

A waterfront city with a rich history, Maryland’s capital has something for everyone. A career with Luminis will help you make the most of it.