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Description
Case Manager, Utilization Review, PRN (Weekends & Holidays)
At the University of Maryland Medical System (UMMS), we are creating a better state of care, for our communities and our team members at more than 150 locations across Maryland.
UMMS believes all team members are caregivers—and we support our caregivers so they can care for our patients. When you join UMMS, you become part of a highly reliable community of more than 27,000, where your experience is respected, your expertise is recognized, and your passion and curiosity are nurtured. A generous benefits package supports your physical, mental, and financial health through a paid time off plan, comprehensive health coverage, dependent care and tuition reimbursement, retirement plan, wellbeing services and more.
UMMS embraces a just culture where all team members are treated fairly and are empowered to communicate their goals and pursue their full career potential. We are guided by our shared values—compassion, discovery, excellence, diversity and integrity—and we are looking for talented individuals who will embrace those values and help us achieve our mission and vision.
UMMS has been recognized as a top employer nationally and most recently is a recipient of the Forbes’ 2023 America’s Best Large Employers award, as well as Newsweek’s 2023 America’s Greatest Workplaces for Diversity and America’s Greatest Workplaces for Women honors.
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Case Manager, Utilization Review, PRN (Weekends & Holidays)
Job ID: REF26361L
Area of Interest: Nursing
Location: La Plata,MD US
Hours of Work: Weekends, holidays
Job Facility: UM Charles Regional Health
Employment Type: Per Diem
Shift: Weekend
Job Description
General Summary
This is a PRN position with a requirement to work a minimum 2 weekend shifts per month & 1 holiday per year.
Under general supervision, provides utilization review 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
- Performs timely and accurate utilization review for all patient populations, using nationally recognized care guidelines/criteria relevant to the payer.
- Communicates with case management team, medical team, and payors as needed regarding reviews and pended/denied days and interventions.
- Ensures appropriate Level of Care and patient status for each patient (Observation, Extended Recovery, Administrative, Inpatient, Critical Care, Intermediate Care, and Med-Surg).
- Reviews tests, procedures, and consultations for appropriate utilization of resources in a timely manner.
Company Description
Our growing community hospital serving Maryland’s Charles County offers all of the services and amenities of a bigger metro hospital with the personal attention of our caring staff. At University of Maryland Charles Regional Medical Center (UM CRMC), our talented and diverse groups of professionals represent our strength. Through teamwork and a collaborative work environment, we proudly serve our patients and our community with unwavering commitment. It’s our passion for people that motivates us to do great work every single day.
We are consistently named among the top 100 Best Places to Work in Maryland. Employees have the opportunity to grow professionally in a supportive and stimulating environment. Our excellent employee benefits support a healthy, balanced lifestyle.
Qualifications
- 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
- Bachelor in Nursing preferred
- Experience
- Three – Fove years clinical experience in a healthcare setting and have previous utilization management experience.
Additional Information
All your information will be kept confidential according to EEO guidelines.
Terms of Service | Need help applying? Contact our Candidate Care Center: 1-443-675-6795
We are an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. EEO IS THE LAW ©2024
