Luminis Health · 5 months ago
Utilization Management Nurse - Emergency department
Lanham, MD
Full-time
Onsite
Mid Level
$34/hr - $55/hr
3+ years expLuminis Health is a healthcare organization focused on providing quality care, and they are seeking a Utilization Management Nurse for their emergency department. The role involves conducting chart reviews, managing denials, and coordinating care to optimize patient outcomes and resource utilization.
Health CareMedicalNon Profit
Responsibilities
Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization information
Provides intervention and coordination to decrease avoidable delays and denial of payment
Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource utilization; enters clinical review in EPIC; maintains close communication with external reviews, care coordinators, and providers; reconciles and records days authorized in EPIC
Monitors and identifies patterns or trends in utilization management; monitors potential and actual denials and collaborates with care coordinator for any follow up necessary; documents actions taken to avoid denial; assists Care Coordinator in communicating with the patient denied hospital days with work toward resolution and discharge
Collaborates with the Care Coordinator to achieve optimal and efficient patient outcomes while decreasing length of stay, avoidable delays and denied days; utilizes Physician Advisor and administrative personnel for unresolved issues; identifies opportunities for expedited appeals and collaborates with the care coordinator and Physician Advisor to resolve payer issues
Participates in nursing unit and department clinical outcome projects as well as process improvement initiatives of care management
Qualification
Required
Bachelor's of Science in Nursing or Associate's degree in Nursing with equivalent experience
BSN must be achieved within 5 years of start date in the role
Three years of clinical nursing in an acute care hospital setting
Current RN license from Maryland Board of Nursing
Benefits
Medical, Dental, and Vision Insurance
Retirement Plan (with employer match for employees who work more than 1000 hours in a calendar year)
Paid Time Off
Tuition Assistance Benefits
Employee Referral Bonus Program
Paid Holidays, Disability, and Life/AD&D for full-time employees
Wellness Programs
Employee Assistance Programs and more*Benefit offerings based on employment status
Company
Luminis Health
Luminis Health is a not for profit organization that provides exceptional health care services.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Amy Beales
Chief Human Resources Officer
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