Utilization Review Manager Jobs in Baltimore, MD

GRADE

20\r\n

LOCATION OF POSITION

MDH, Maryland Healthcare System, 55 Wade Ave, Catonsville, MD\r\n

Main Purpose of Job

This position is responsible for conducting reviews on admissions, continued stays, and readmissions, as well as managing the denial process. This position is vital to addressing the Maryland Department of Health (MDH) waitlist by identifying patients who no longer meet medical necessity criteria for inpatient care. These reviews are conducted independently of treatment teams to provide objective feedback to hospitals regarding patient progress.\r\nThis position also manages the appeal process, working with the Physician Advisor when patients do not meet medical necessity criteria. Cases are presented to the Utilization Review to recommend the committee to determine if a second Physician Advisor review is required.\r\nThis is a hybrid position that allows for teleworking.\r\nThis position provides reports that identify opportunities to improve care through medical record reviews. These improvements may include the adequacy of documentation regarding patient progress, missing or insufficient records, the absence of required assessments, and the overall quality of treatment.\r\n

MINIMUM QUALIFICATIONS

Education: Determined by the Maryland State Board of Nursing under the licensing requirements for Registered Nurses.\r\nExperience: None. \r\n

DESIRED OR PREFERRED QUALIFICATIONS

The desired candidate should possess the following:\r\n\r\n\r\n Experience using Google Suites (especially Google Sheets) to complete NRI statistics and maintain utilization review files and the UR database\r\n Experience in Risk Management\r\n\r\n\r\n

LICENSES, REGISTRATIONS AND CERTIFICATIONS

1. Candidates for positions in this classification must possess a current license as a Registered Nurse from the Maryland State Board of Nursing, 4140 Patterson Avenue, Baltimore, Maryland 21215 or possess a current multi-state license in party states that candidates have declared as primary states of residence. \r\n2. Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operator's license valid in the State of Maryland. \r\n3. Employees in this classification may be required to successfully complete and maintain current certification of cardiopulmonary resuscitation training. \r\n

SPECIAL REQUIREMENTS

1. Employees in this classification are subject to call-in and, therefore, will be required to provide the facility with a phone number at which they can be reached. \r\n2. Employees in this classification are subject to substance abuse testing in accordance with Code of Maryland Regulations 17.04.09, Testing for Illegal Use of Drugs. \r\n

SELECTION PROCESS

Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position.Therefore, it is essential that you provide complete and accurate information on your application.Please report all related education, experience, dates and hours of work.Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview).\r\nComplete applications must be submitted by the closing date.Information submitted after this date will not be added.\r\nIncorrect application forms will not be accepted.Resumes will not be accepted in lieu of a completed application.\r\nCandidates may remain on thecertified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.\r\n

BENEFITS

STATE OF MARYLAND BENEFITS\r\n

FURTHER INSTRUCTIONS

Online applications are highly recommended. However, if you are unable to apply online,the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201.Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.\r\nIf additional information is required, the preferred method is to upload. If you are unable to upload, please fax the requested informationto 410-333-5689.Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time.\r\nFor questions regarding this recruitment, please contact theMDH Recruitment and Selection Division at 410-767-1251.\r\nIf you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at 410-767-4850 orApplication.Help@maryland.gov.\r\nAppropriate accommodations for individuals with disabilities are available upon request by calling: 410-767-1251 or MD TTY Relay Service 1-800-735-2258.\r\nWe thank our Veterans for their service to our country.\r\nPeople with disabilities and bilingual candidates are encouraged to apply.\r\nAs an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.\r\n