Job Description

Under general supervision, provides utilization management, care coordination and discharge planning for an assigned patient case load. This role is patient focused, outcome-oriented, and based on general and specialty professional standards, and functions within a multi-disciplinary practice model; and other duties as assigned.

EDUCATION and/or EXPERIENCE

• Licensed as a Registered Nurse (RN) in the state of Maryland. Graduation from an accredited school is required
• Master’s degree or certification as Case Manager preferred
• Minimum of 5 years clinical nursing experience. Experience in acute care, as well as home health, ambulatory care and/or occupational health is preferred
• Knowledge of managed care, discharge planning, utilization and case management is required
• Experience in case management and knowledge of payer mechanisms and clinical utilization management is highly preferred

ESSENTIAL JOB FUNCTIONS

1. Coordinates the integration of social services/case management functions into the patient care, discharge, and home planning processes with other hospital departments, external service organizations, agencies and healthcare facilities.
2. Conducts concurrent medical record review using specific indicators and criteria as approved by medical staff, JCAHO, CMS, and other state agencies.
3. Acts as patient advocate: investigates and reports adverse occurrences, and performs staff education related to resource utilization, discharge planning and psychosocial aspects of healthcare delivery.
4. Promotes effective and efficient utilization of clinical resources.
5. Mobilizes resources and interviews, as needed, to achieve expected goal to assist in achieving desired clinical outcomes within the desired timeframe.
6. Ensures that patient tests are appropriate and necessary and are carried out within the established timeframe and that results are promptly available.
7. Conducts review for appropriate utilization of services from admission through discharge. Evaluate patient satisfaction and quality of care provided.
8. Initiates and presents “denial letters”, as appropriate.
9. Assesses patient care required throughout continuum of care for diagnosis, procedures and DRG’s.
10. Communicates with physicians at regular intervals throughout hospitalization and develops an effective working relationship.

Total Rewards
The referenced base salary range represents the low and high end of University of Maryland’s Faculty Physician’s Inc. salary range for this position. Some candidates will not be eligible for the upper end of the salary range. Exact salary will ultimately depend on multiple factors, which may include the successful candidate's geographic location, skills, work experience, market conditions, internal equity, responsibility factor and span of control, education/training and other qualifications. University of Maryland Faculty Physician’s Inc. offers a total rewards package that supports our employees' health, life, career and retirement. More information can be found here: https://www.umfpi.org/jobs/summary-employee-benefits

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