Concurrent Review Nurse (part time)
MCMI is responsible for managing Maryland Physician Care's (MPC) statewide provider network of hospitals and physicians.
Maryland Physicians Care has been providing services to the HealthChoice Medicaid populations since 1996.
With over 240,000 members, MPC consistently has been one of the third largest managed care organizations in MD.
In order to provide and maintain a safe work environment and healthy workforce, MCMI requires COVID-19 vaccinations of all employees.
All incumbents must provide proof of full vaccination upon hire.
This position is part-time with no health and welfare benefits.
Summary/Position Objectives:
This position is responsible for evaluating the quality, effectiveness, timeliness, and appropriateness of facility-based care.
Facility-based care includes inpatient hospital, skilled nursing care, rehabilitation, sub-acute and inpatient hospice.
The incumbent is responsible to facilitate the timely provision of care to members for appropriate utilization of health care resources using approved medical criteria and to facilitate timely discharge in conjunction with facility staff.
Responsibilities:
Essential Functions:
Reviews members' facility medical records and conducts concurrent review to assess the appropriateness of facility-based care, including abstracting appropriate clinical information.
Evaluates for the appropriate level or location of care and anticipated length of stay.
Communicates with the Medical Director as necessary to support the concurrent review functionCommunicates with the attending and primary care physicians on an on-going basis.
Communicates with hospital case managers, discharge planners and other facility staff on an on-going basis.
Participates in patient conferences, family conferences and regular staffing for in-patient admissions.
Participates in UM and Case Management Rounds as indicated.
Functions as liaison and problem solver for all Concurrent Review related issues.
Gathers and reports pertinent data, including quality and utilization indicator information and other applicable information.
Maintains confidentiality of the member's medical information.
Identifies and refers members to case management, disease management and other programs to assist the member in accessing appropriate health care services.
A'.
Routinely meets with patients and families to explain benefits and treatment planning, as applicable.
A'.
Participates in Transition of Care Activities to avoid readmissions.
Education and Work
Experience:
Registered Nurse and Bachelor's or Associate degreeBSN preferredCurrent RN license in state of MarylandRequires three (3) years clinical/hospital nursing experience, such as ICU, medical/surgical, OB/maternity, etc.
Minimum of one (1) year experience in Managed Care and/or three (3) years experience in UR/UM Concurrent Review experience preferred.
SDL2017.
Estimated Salary: $20 to $28 per hour based on qualifications.
Maryland Physicians Care has been providing services to the HealthChoice Medicaid populations since 1996.
With over 240,000 members, MPC consistently has been one of the third largest managed care organizations in MD.
In order to provide and maintain a safe work environment and healthy workforce, MCMI requires COVID-19 vaccinations of all employees.
All incumbents must provide proof of full vaccination upon hire.
This position is part-time with no health and welfare benefits.
Summary/Position Objectives:
This position is responsible for evaluating the quality, effectiveness, timeliness, and appropriateness of facility-based care.
Facility-based care includes inpatient hospital, skilled nursing care, rehabilitation, sub-acute and inpatient hospice.
The incumbent is responsible to facilitate the timely provision of care to members for appropriate utilization of health care resources using approved medical criteria and to facilitate timely discharge in conjunction with facility staff.
Responsibilities:
Essential Functions:
Reviews members' facility medical records and conducts concurrent review to assess the appropriateness of facility-based care, including abstracting appropriate clinical information.
Evaluates for the appropriate level or location of care and anticipated length of stay.
Communicates with the Medical Director as necessary to support the concurrent review functionCommunicates with the attending and primary care physicians on an on-going basis.
Communicates with hospital case managers, discharge planners and other facility staff on an on-going basis.
Participates in patient conferences, family conferences and regular staffing for in-patient admissions.
Participates in UM and Case Management Rounds as indicated.
Functions as liaison and problem solver for all Concurrent Review related issues.
Gathers and reports pertinent data, including quality and utilization indicator information and other applicable information.
Maintains confidentiality of the member's medical information.
Identifies and refers members to case management, disease management and other programs to assist the member in accessing appropriate health care services.
A'.
Routinely meets with patients and families to explain benefits and treatment planning, as applicable.
A'.
Participates in Transition of Care Activities to avoid readmissions.
Education and Work
Experience:
Registered Nurse and Bachelor's or Associate degreeBSN preferredCurrent RN license in state of MarylandRequires three (3) years clinical/hospital nursing experience, such as ICU, medical/surgical, OB/maternity, etc.
Minimum of one (1) year experience in Managed Care and/or three (3) years experience in UR/UM Concurrent Review experience preferred.
SDL2017.
Estimated Salary: $20 to $28 per hour based on qualifications.
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