Urgent! Utilization Reviewer Job Opening In Largo – Now Hiring University of Maryland Medical System
Job Description
Location: Largo, MD - Onsite
Hours: 8am- 4:30pm, rotating weekends and some holidays.
General Summary
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.
Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by staff assigned to this classification.
They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
1. Performs timely and accurate utilization review for all patient populations, using nationally recognized care guidelines/criteria relevant to the payer.
2. Communicates with clinical care coordinators, physician advisor, medical team and payors as needed regarding reviews and pended/denied days and interventions.
3. Supports concurrent appeals process through proactive identification of pended/denied days.
Implements the concurrent appeals process with appropriate referrals and documentation.
4. Ensures appropriate Level of Care and patient status for each patient (Observation, Extended Recovery, Administrative, Inpatient, Critical Care, Intermediate Care, and Med-Surg).
5. Reviews tests, procedures and consultations for appropriate utilization of resources in a timely manner.
6. Conducts HINN discussions/Observation Education.
7. Collaborates with Clinical Care Coordinators concerning Avoidable Days Collection.
8. Ensures Regulatory Compliance related to Utilization Management conditions of participation.
9. Assures appropriate reimbursement and stewardship of organizational and patient resources.
10. Pursues and reports opportunities to improve reimbursement.
11. Collaborates with admitting specialists regarding authorization policies and procedures of third party payers.
12. Remains current on clinical practice and protocols impacting clinical reimbursement.
Patient Safety
Ensures patient safety in the performance of job functions and through participation in hospital, department or unit patient safety initiatives.
1. Takes action to correct observed risks to patient safety.
2. Reports adverse events and near misses to appropriate management authority.
3. Identifies possible risks in processes, procedures, devices and communicates the same to those in charge.
Licensure
Licensure as a Registered Nurse in the state of Maryland, or eligible to practice due to Compact state agreements outlined through the MD Board of Nursing, is required
Education
Bachelors in Nursing required.
Experience
One year of experience in case management or utilization management with knowledge of payer mechanisms and utilization management is preferred.
Two years’ experience in acute care and four years clinical healthcare experience preferred.
Certified Professional Utilization Reviewer (CPUR) preferred.
Additional experience in home health, ambulatory care, and/or occupational health is preferred.
Knowledge, Skills and Abilities
1. Highly effective verbal and written skills are required.
2. Strong communication skills, self-confidence and experience in working with physicians are required.
3. Excellent analytical and team building skills, as well as the ability to prioritize and work independently are required.
4. The ability to work collaboratively with other disciplines is required.
5. Ability to work with Hospital/ Utilization Management and related software programs is required.
6. Knowledge of utilization management is preferred.
All your information will be kept confidential according to EEO guidelines.
Compensation
Like many employers, UMMS is being targeted by cybercriminals impersonating our recruiters and offering fake job opportunities.
We will never ask for banking details, personal identification, or payment via email or text.
If you suspect fraud, please contact us at careers@umms.edu.
✨ Smart • Intelligent • Private • Secure
Practice for Any Interview Q&A (AI Enabled)
Predict interview Q&A (AI Supported)
Mock interview trainer (AI Supported)
Ace behavioral interviews (AI Powered)
Record interview questions (Confidential)
Master your interviews
Track your answers (Confidential)
Schedule your applications (Confidential)
Create perfect cover letters (AI Supported)
Analyze your resume (NLP Supported)
ATS compatibility check (AI Supported)
Optimize your applications (AI Supported)
O*NET Supported
O*NET Supported
O*NET Supported
O*NET Supported
O*NET Supported
European Union Recommended
Institution Recommended
Institution Recommended
Researcher Recommended
IT Savvy Recommended
Trades Recommended
O*NET Supported
Artist Recommended
Researchers Recommended
Create your account
Access your account
Create your professional profile
Preview your profile
Your saved opportunities
Reviews you've given
Companies you follow
Discover employers
O*NET Supported
Common questions answered
Help for job seekers
How matching works
Customized job suggestions
Fast application process
Manage alert settings
Understanding alerts
How we match resumes
Professional branding guide
Increase your visibility
Get verified status
Learn about our AI
How ATS ranks you
AI-powered matching
Join thousands of professionals who've advanced their careers with our platform
Unlock Your Utilization Reviewer Potential: Insight & Career Growth Guide
Real-time Utilization Reviewer Jobs Trends in Largo, United States (Graphical Representation)
Explore profound insights with Expertini's real-time, in-depth analysis, showcased through the graph below. This graph displays the job market trends for Utilization Reviewer in Largo, United States using a bar chart to represent the number of jobs available and a trend line to illustrate the trend over time. Specifically, the graph shows 2707 jobs in United States and 3 jobs in Largo. This comprehensive analysis highlights market share and opportunities for professionals in Utilization Reviewer roles. These dynamic trends provide a better understanding of the job market landscape in these regions.
Great news! University of Maryland Medical System is currently hiring and seeking a Utilization Reviewer to join their team. Feel free to download the job details.
Wait no longer! Are you also interested in exploring similar jobs? Search now: Utilization Reviewer Jobs Largo.
An organization's rules and standards set how people should be treated in the office and how different situations should be handled. The work culture at University of Maryland Medical System adheres to the cultural norms as outlined by Expertini.
The fundamental ethical values are:The average salary range for a Utilization Reviewer Jobs United States varies, but the pay scale is rated "Standard" in Largo. Salary levels may vary depending on your industry, experience, and skills. It's essential to research and negotiate effectively. We advise reading the full job specification before proceeding with the application to understand the salary package.
Key qualifications for Utilization Reviewer typically include Information And Record Clerks and a list of qualifications and expertise as mentioned in the job specification. Be sure to check the specific job listing for detailed requirements and qualifications.
To improve your chances of getting hired for Utilization Reviewer, consider enhancing your skills. Check your CV/Résumé Score with our free Resume Scoring Tool. We have an in-built Resume Scoring tool that gives you the matching score for each job based on your CV/Résumé once it is uploaded. This can help you align your CV/Résumé according to the job requirements and enhance your skills if needed.
Here are some tips to help you prepare for and ace your job interview:
Before the Interview:To prepare for your Utilization Reviewer interview at University of Maryland Medical System, research the company, understand the job requirements, and practice common interview questions.
Highlight your leadership skills, achievements, and strategic thinking abilities. Be prepared to discuss your experience with HR, including your approach to meeting targets as a team player. Additionally, review the University of Maryland Medical System's products or services and be prepared to discuss how you can contribute to their success.
By following these tips, you can increase your chances of making a positive impression and landing the job!
Setting up job alerts for Utilization Reviewer is easy with United States Jobs Expertini. Simply visit our job alerts page here, enter your preferred job title and location, and choose how often you want to receive notifications. You'll get the latest job openings sent directly to your email for FREE!