Utilization Clinical Coordinator

Utilization Clinical Coordinator

Full Time, M-F, Days (Occasional weekends as needed) 

The UM Clinical Coordinator is a Registered Nurse or LPN with strong clinical skills and utilization experience and working toward their RN, with demonstrated outstanding clinical and leadership skills. Responsible for assisting the Clinical Manager with maintaining the day to day operations related to utilization management and providing unit leadership. This position will be 70% clinical and 30% leadership. The Clinical Coordinator will have responsibility for: Care management work q's, participate and lead quality improvement initiatives, support and lead customer service initiatives, work collaborativelywith physicians  and provide education on utilization and denial patterns, assist the Clinical Manager with performance appraisals, and work collaboratively with physicians, nursing staff, ancillary departments and insurance partners and reviewers, maintains updated and education related to changes to criteria utilized for UM.  Adheres to ethical principles as defined by the Nurse Practice Act and the ANA code of ethics in nursing.  Addresses breaches in clinical standards. Responsible for provisions of services consistent with the mission and goals of the system, meeting or exceeding quality outcomes and regulatory and financial goals.

Education - Associate Degree in Nursing required.  Bachelor of Science in Nursing preferred

Experience - A minimum of 3 years of acute care or combination of 3 years in acute care, Utilization role, SNF, or community health setting. Experience in a Leadership role such as committee chair, resource nurse education or management preferred.

Licensure/Certification - Knowledge and use of utilization review criteria preferred, multi-tasking required, knowledge of evidenced based practices preferred, in depth knowledge of disease processes, knowledge of regulatory requirements, computer skills required, electronic medical record navigation strongly preferred, knowledge of the revenue cycle, knowledge of community resources and medical staff community is of strong benefit. designated as “Compact” or “Multi-State Privilege” using primary source verification and provides additional documentation as required by the Maryland Board of Nursing. RN license from a compact state with a designation of “Single State” does not meet the requirement and nurse must obtain a Maryland license. BLS(CPR) in compliance with policy required. Utilization Certification required within two years of hire date. Additional job requirements based on assigned unit as reflected in Addendum to Registered Nurse job description required. Professional certification in area of clinical specialty preferred and/or obtained within 3 years. 

Knowledge/Skills/Abilities - Strong team work ethic while also able to work independently with minimal supervision. Ability to work in stressful environments while maintaining a professional attitude in communication with staff, medical providers, and other members of the team. Strong oral, written, and interpersonal communication skills.  Ability to maintain objectivity and confidentiality. Performance Exceeds in core values and code of conduct.

Caring for Our Team
We offer a comprehensive benefits package to support our employees' well-being and professional growth. Benefits include health, dental, and vision insurance available starting the first day of the month following 30 days of employment, along with life insurance, short and long-term disability coverage. Paid Time Off begins accruing from day one, and we also provide a 401k plan, an education assistance program, and an employee assistance program. Additionally, employees working evening, night, or weekend shifts may be eligible for a shift differential, adding even more value to your role.

Strength Through Diversity 

Meritus Health believes that diversity, equity, and inclusion are key drivers for excellence. We share a common devotion to delivering exceptional patient care. When you join us, you become a part of Meritus Health, and we expect a record of achievement and advancement as we meet our mission.

Our commitment to equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to create joy at work and reach their potential.

Happy to Help

At Meritus, we believe in a collaborative and caring work environment. Interactions are an opportunity to learn, listen and to be there for one another. Therefore, we provide warm welcomes, hos