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Regional UM Nurse Reviewer

Company: Corizon Health, Inc.
Location: Hanover
Posted on: April 21, 2019

Job Description:

We have an exceptional opportunity for a full time Utilization Management Registered Nurse (RN) Reviewer to join our healthcare team at Corizon's Maryland Regional Office located in Hanover, MD. The qualified candidate will have experience with InterQual and/or Milliman Care Guidelines. Hours: 8am-5pm, M-F (no weekends). Job Summary of the Corizon Health Utilization Management Registered Nurse (RN) The Utilization Management Specialist is responsible for the implementation of a comprehensive outpatient/inpatient review process utilizing criteria based review standards and standards of best practice. Assist in the control of utilization of resources, pre-occurrence monitoring, concurrent monitoring, intervention and retrospective review. Track, trend and evaluate appropriateness and quality of care issues with the implementation of education to internal and external customers and process improvement initiatives. Qualifications of the Corizon Health Utilization Management Registered Nurse (RN) Experience Level: 3 - 5 years experience in utilization management, case management, quality management. Experience with InterQual and/or Milliman Care guidelines. Strong organizational and time management skills. Experience with both Inpatient and Outpatient review process preferred. Tools and Technology: Computer usage for word processing, spreadsheets, email, internet, medical records and other proprietary company/client systems. Certificates and Licenses: Registered Nurse (RN) active license Language Ability: Strong verbal, written communication skills. Effectively present information in one-on-one and group situations to nursing staff, clients and other employees of the organization. Reasoning Ability: Ability to work on extremely complex problems where analysis of situations or data requires an evaluation of intangible variance factors. Work Environment: Office environment with occasional travel up to 10% to regional offices, client and/or vendor sites. The Utilization Management Specialist is responsible for the implementation of a comprehensive outpatient/inpatient review process utilizing criteria based review standards and standards of best practice. Assist in the control of utilization of resources, pre-occurrence monitoring, concurrent monitoring, intervention and retrospective review. Track, trend and evaluate appropriateness and quality of care issues with the implementation of education to internal and external customers and process improvement initiatives. Responsible for the implementation of a comprehensive outpatient/inpatient review process utilizing criteria based review standards and standards of best practice. Facilitate quality health care intervention recommendations. Ability to manage a variety of caseload situations and maintain the caseload as required Review and assess over/under utilization issues. Track, trend and evaluate appropriateness and quality of care issues with the implementation of education to internal and external customers and process improvement initiatives. Respond to inquiries by provider/site employees relating to standards of care and best practices. Ability to establish and maintain working relationship with UM Medical Directors/contract Medical Directors. Develop and maintain pre-established review parameters under UM Medical Director/contract Medical Director lead Identify and document comparisons with community standards, regionally based as indicated. Work with other UM inpatient and outpatient nurse reviewers to assure proper treatment in the appropriate setting at the appropriate time. Communicate and document any issues relating to the outpatient/inpatient UM process to the Manager of Utilization Management. Assist with the data collection and reporting related to the UM outpatient/inpatient process. Participate in CEU offerings/seminars to enhance professional growth and development and the maintenance of nursing license. Recommend improvements to process and outcomes using data analysis tools, logical rules/relations and data elements. Assist in completion of special projects on an as needed basis. For questions contact Carolyn Coney-Johnson, Sr. Clinical Recruiter at 615-660-6814 or Carolyn.coneyjohnson@corizonhealth.com This position may require a background check, security clearance, and/or drug screening. Corizon Health is an Equal Opportunity Employer. In compliance with federal and state employment opportunity laws, qualified applicants are considered for all positions without regard to race, gender, national origin, religion, age, sexual orientation, disability, Vietnam era veteran, or disabled Veteran status. The Utilization Management Specialist is responsible for the implementation of a comprehensive outpatient/inpatient review process utilizing criteria based review standards and standards of best practice. Assist in the control of utilization of resources, pre-occurrence monitoring, concurrent monitoring, intervention and retrospective review. Track, trend and evaluate appropriateness and quality of care issues with the implementation of education to internal and external customers and process improvement initiatives. Responsibilities of the Corizon Health Utilization Management Registered Nurse (RN) Responsible for the implementation of a comprehensive outpatient/inpatient review process utilizing criteria based review standards and standards of best practice. Facilitate quality health care intervention recommendations. Ability to manage a variety of caseload situations and maintain the caseload as required Review and assess over/under utilization issues. Track, trend and evaluate appropriateness and quality of care issues with the implementation of education to internal and external customers and process improvement initiatives. Respond to inquiries by provider/site employees relating to standards of care and best practices. Ability to establish and maintain working relationship with UM Medical Directors/contract Medical Directors. Develop and maintain pre-established review parameters under UM Medical Director/contract Medical Director lead Identify and document comparisons with community standards, regionally based as indicated. Work with other UM inpatient and outpatient nurse reviewers to assure proper treatment in the appropriate setting at the appropriate time. Communicate and document any issues relating to the outpatient/inpatient UM process to the Manager of Utilization Management. Assist with the data collection and reporting related to the UM outpatient/inpatient process. Participate in CEU offerings/seminars to enhance professional growth and development and the maintenance of nursing license. Recommend improvements to process and outcomes using data analysis tools, logical rules/relations and data elements. Assist in completion of special projects on an as needed basis. Benefits offered to the Corizon Health Utilization Management Registered Nurse (RN) Paid Time Off Medical, Dental and Vision Insurance Tuition Assistance 401(k) with company match Free online Continuing Education program Comprehensive Onboarding Mentor and Preceptor Programs Corizon Health provides patients with high quality healthcare and reentry services that will reduce recidivism and better the communities where we live and work. We are dedicated to meeting the needs of the growing number of incarcerated persons with physical and mental illness and the professionals who care for them. More healthcare professionals are finding the stability and advancement they desire at Corizon Health. This position may require a background check, security clearance, and/or drug screening. Corizon Health is an Equal Opportunity Employer. In compliance with federal and state employment opportunity laws, qualified applicants are considered for all positions without regard to race, gender, national origin, religion, age, sexual orientation, disability, Vietnam era veteran, or disabled Veteran status. Job Number:14994Corizon Health.Category: Healthcare, Keywords: Registered Nurse (RN)

Keywords: Corizon Health, Inc., Baltimore , Regional UM Nurse Reviewer, Healthcare , Hanover, Maryland

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