Utilization Review Nurse RN - PRN

Responsibilities

• Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource consumption.
• Enters clinical reviews into the software program.
• Maintains close communication with external reviewers/internal financial counselors/patient access personnel and performs certification activities as required by payor.
• Monitors and identifies patterns or trends in utilization management.
• Marks potential and actual denials and coordinates with nurse Care Manager and/or Social Worker for any follow up necessary.
• Documents in software program the actions taken to coordinate care and avoid denials.
• Aids nurse Care Managers in communicating with the patient denied hospital days as well as the issuance of Medicare forms including HINN, Detailed Notice of Discharge to patients/family/significant other when they are in disagreement with the discharge plan arranged by attending and Care Management personnel.
• Collaborates with the Care Manager and Physician Advisor to resolve payer issues.
• Sends appropriate referrals/escalations to the physician advisors to review cases not met with criteria.

Requirements

• Registered Nurse License - Current Maryland license or eligibility to obtain Maryland license
• Associate's Degree in Nursing required; BSN or higher preferred
• Minimum of 3 years of related experience

Qualifications

LifeBridge Health is a dynamic, purpose-driven health system redefining care delivery across the mid-Atlantic and beyond, anchored by our mission to “improve the health of people in the communities we serve.” Join us to advance health access, elevate patient experiences, and contribute to a system that values bold ideas and community-centered care.

Skills

N/A

Benefits

Competitive compensation (additional compensation such as overtime, shift differentials, premium pay, and bonuses may apply depending on job), comprehensive health plans, free parking, and wellness programs.

Pay

$50.00-$50.00

Schedule

PRN - As Needed - Hours Vary