Summary

Position Summary:

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.

Essential Functions:

Chart Review

Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource consumption.

Denial Management

Monitors and identifies patterns or trends in utilization management.

Care Coordination

Coordinates with the Care Manager to achieve optimal and efficient patient outcomes, while decreasing length of stay and avoid delays and denied days.

 

Qualifications/Requirements

Education/Knowledge:

Basic professional knowledge; equivalent to a Bachelor's degree; working knowledge of theory and practice within a specialized field

Education Discipline:  Minimal degree requirement: Bachelor of Science in Nursing.

Experience:  3-5 years.  

Must possess strong critical thinking skills, have an ability to perform clinical/chart review and abstract information efficiently

Certifications, Licenses, Registrations:

Maryland Registered Nurse License

American Heart Association BLS Certification

Additional Information

As one of the largest health care providers in Maryland, with 13,000 team members, We strive to CARE BRAVELY for over 1 million patients annually. LifeBridge Health includes Sinai Hospital of Baltimore, Northwest Hospital, Carroll Hospital, Levindale Hebrew Geriatric Center and Hospital and Grace Medical Center, as well as our Community Physician Enterprise, Center for Hope, Practice Dynamics, and business partners: LifeBridge Health & Fitness, ExpressCare and HomeCare of Maryland.