RN Utilization Review

Assumes Utilization Review functions for all patients located in the ED and inpatient settings with the goal of preserving revenue and minimizing denials for inpatient and observation cases.  Revenue integrity and denial management. Initiates clinical review, denials / appeals and medical necessity for those being placed in a clinical bed to ensure “right patient / right level of care.”

Whether you grew up on the Eastern Shore or plan to relocate here, you'll find the benefits at Atlantic General Hospital outstanding:

• Support for continuing education & professional development
• Tuition Reimbursement
• Incentive Bonus Program
• Wellness Program with services and discounts... and more

We are actively searching for a RN Utilization Review. This position assumes Care Coordination and Utilization Review functions for all patients. Facilitates the collaborative management of patient to prevent E.D. recidivism, un-necessary admissions and re-admissions.  Initiates clinical review, denials / appeals and medical necessity for those being placed in a clinical bed to ensure “right patient / right level of care.”   

The ideal candidate will have graduated from an accredited RN nursing program with a Bachelor’s degree, and hold an active RN license. Must have 2-5 years clinical experience and prior experience in Case Management. Prior Utilization Review experience and knowledge of MCG (Milliman) criteria is preferred. Must have knowledge of community based resources. Ability to multi-task and perform functions in a fast-paced setting, and knowledge of insurance and associated coordination of healthcare services is required.  

Medical, Dental, Vision, Flex Spend for Medical & Dependent Care, Paid Life Insurance, Vol Life Insurance, Short Term disability, Tuition Reimbursement, Retirement with Company Match, Paid Time Off…. and more! 

Salary Range: $34.00 hour - $56.10 hour (Credit is given with relevant experience)