Utilization Management RN: Streamline Care & Denials

Luminis Health, Inc.; Lanham (MD); Sur place; USD 34 000 - 55 000; Plein temps

Résumé du poste

Luminis Health is seeking a Registered Nurse to perform concurrent and retrospective chart reviews to assess clinical, financial, and resource utilization and to coordinate care. The role includes intervention to reduce delays and denials, working with care coordinators and physicians to resolve payer issues, and participating in process-improvement initiatives.

Requirements include a BSN (or ADN with equivalent experience) and at least three years of acute care nursing, with an active Maryland

Qualifications

• RN license required (Maryland Board of Nursing)
• BSN must be achieved within 5 years of start date
• Three years of clinical nursing in an acute care hospital setting

Responsabilités

• Conduites concurrent and retrospective chart review to assess clinical, financial, and resource utilization.
• Monitor denial patterns and collaborate with care coordinators to resolve and prevent denials.
• Collaborate with care coordinators to achieve optimal patient outcomes, shorten length of stay, and expedite appeals when needed.
• Participate in nursing unit and department clinical outcome projects and care management process improvements.

Connaissances

Chart review

Denial management

Care coordination

Process improvement

Formation

Bachelor of Science in Nursing

Associate degree in Nursing

Outils

EPIC

Description du poste

Luminis Health is seeking a Registered Nurse to perform concurrent and retrospective chart reviews to assess clinical, financial, and resource utilization and to coordinate care. The role includes intervention to reduce delays and denials, working with care coordinators and physicians to resolve payer issues, and participating in process-improvement initiatives.

Requirements include a BSN (or ADN with equivalent experience) and at least three years of acute care nursing, with an active Maryland