RN Utilization Review – On Call, BWMC
RN Utilization Review – On Call, BWMC
Primary Location: Glen Burnie, Maryland
Job Number: 1138346
Date posted: 12/10/2022
JOB DESCRIPTION
SUMMARY:
In conjunction with a MAPMG member, the patient care coordinator is in charge of utilization review, discharge preparation, and care transitions in acute or alternative sites of care.
Significant Duties:
Utilization Review: Apply authorized utilization review criteria and guidelines consistently for services provided in acute or alternate care settings, in accordance with departmental policy, procedure, and protocols.
Verification of benefits and eligibility: Verify eligibility and ensure that benefits are administered properly in accordance with departmental policies and guidelines.
Choosing the Best Care Location with a Hospitalist: Collaboration with the Hospitalist to determine the proper level of care for patients during (Home, Continuum, or Community-based Services) and after (Medical Unit, Surgical Unit, Tele Unit, TCU, and ICU) hospitalization.
Care Coordination: driving the patient care plan by ensuring that the daily plan is followed, managing transitions, and providing post-hospital care.
Planning a discharge effectively: Planning for discharge that is prompt and clinically appropriate and starts at the time of admission.
Variance Control: Throughput delays should be identified quickly, escalated to remedy delays, and recorded to find patterns and trends that call for corrective action.
Quality Inspection: Show that you have the skills necessary to identify any deviations from quality and utilization standards in all facets of care across the continuum.
Carries out further related tasks as directed.
Work every other weekend.
Read also employees expected conduct for this job
Basic requirements:
Experience
- Acute care environment experience as an RN of no less than one (1) year.
Education
- License, Certification, and Registration
- Credentials from several states are required for this position. Before being hired, credentials from the major employment state are required. After hiring, additional credentials from the secondary work state(s) are needed.
- Virginia Registered Nurse License within six months of employment AND Maryland Registered Nurse License within six months of employment.
OR
- Within six months of hire, a registered nurse with a compact license
- Within six months of employment, a District of Columbia registered nurse license
- First Aid/Life Support
Additional requirements include:
- Completing the PCC Assessment of Critical Skills successfully every year.
- A satisfactory inter-rater reliability rating.
- Ability to speak clearly.
- Ability to follow rules and guidelines that have been established.
- The capacity to solve problems and make judgments analytically.
- The capacity to put up with and handle ambiguity.
- Ability to contribute to a team.
- Knowledge of how to use the relevant software
- Experience in case management, home health, or recent acute care is preferred.
- Ability to listen carefully, and influence or persuade people through oral presentation in favorable or unfavorable conditions.
- Demonstrated proficiency in presenting ideas and recording activities through writing, as well as in reading and interpreting written information.
- B.S.N. preferred.
NOTE:
Maryland's primary location is the Baltimore Washington Medical Center in Glen Burnie.
8 scheduled hours per week, day shift
Saturday and Sunday are workdays.
Start of Business: 8:00 AM
The workday ends at 5:00 PM
Work Schedule: Limited Hours
Position Type: Regular
Regular Employee Group/Union Membership: M37|UFCW|Local 27
Department: Baltimore Washington Medical Center – UR-Discharge Planning – 1808 Job Level: Individual Contributor
Travel: 5% of the time, yes
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