Responsible for performing utilization management.Proactively review, identify and document potentially avoidable utilization and patient quality/efficiency concerns.Work collaboratively with internal team as well as external entities to reduce potentially avoidable utilization and denials.Evaluates utilization documentation and recommends processes related to optimal reimbursement and compliance.Perform compliance tasks related to utilization.Orient new team members to acute care criteria.

Education & Training: Current Maryland RN license required.Bachelors of Science degree in Nursing preferred.

Work Orientation & Experience:

Minimum of 3 years acute care experience required. Experience in utilization management, case management and discharge planning preferred.Basic computer skills required.

Skills & Abilities:

Demonstrate skill in a) performing complete clinical assessments; b) effective critical thinking skills both written and oral; and c) age appropriate interpersonal interactions (patients may range from newborn to geriatric adult.)

Ability to a) communicate and collaborate effectively with both internal and external customers (colleagues, Medical Staff, liaisons, and patient/family); b) assess, adapt, and calmly respond to changing and/or crisis environment; c) make independent decisions consistent with current policies, procedures, and ethical standards; d) prioritize work assignments and manage time effectively to complete duties; and e) assist in data analysis.

REPORTING RELATIONSHIPS:

Supervised by: Director of Utilization Management

Supervision provided to: None.