Emergency Department Utilization Review Registered Nurse, 9:00AM-5:30PM, with some holiday and weekend on-call coverage

apartment GBMC Healthcare location_onTowson, MD, US

Under general supervision, provides consultative support to the admitting teams concerning patient status determinations and utilization of resources for patients requiring hospital services. Works collaboratively with interdisciplinary teams facilitating appropriate status determinations through the utilization review process supporting quality, cost-effective patient outcomes. Responsible for analyzing clinical information and performing timely initial and concurrent reviews using InterQual screening software.

Education

Bachelor of Science in Nursing (BSN) OR Associate of Science in Nursing and currently enrolled in a BSN program with an expected graduation date within three (3) years.

Experience

Five (5) years diversified, progressive experience in acute care and/or other settings within the continuum required.

Two (2) years of Utilization Management experience which includes utilization review processes and discharge planning preferred.

Knowledge, Skills and Abilities

Advanced knowledge of InterQual and/or MCG admission criteria
Knowledge of healthcare regulatory standards
Advanced skill in using computer software
Advanced skill in oral and written communication
Advanced skill in critical thinking
Ability to work independently and resolve complex problems
Ability to remain calm under pressure and intense time constraints
Strong analytical and problem solving skills
Strong interpersonal communication skills
Strong organizational and time management skills
Proficiency in electronic medical record review

Licensures, Certifications

Current state of Maryland Registered Nurse license
Bachelor of Science in Nursing (BSN) OR documentation of current enrollment in BSN program with expected graduation within three years of hire
Certification in Utilization Management and/or Care Management highly desired.

Physical Requirements

Ability to sit, stand, stoop, and bend.

Working Conditions

Primarily in an office environment, evaluating electronic medical records and performing electronic documentation and communication 70% of time. Remainder of time working with interdisciplinary staff

Conditions of Employment

Maintain current licensure

Principal Duties and Responsibilities

Reviews available electronic medical records during the pre-admission process to determine appropriate patient status, optimizing correct patient classification and corresponding payer notifications.

Develops initial admission reviews for patients requiring hospital services and provides timely status recommendations to admitting providers in accordance with departmental and clinical guidelines.

Maintains a working knowledge of contractual and clinical criteria guidelines. Assures timely utilization compliance with all payers who require authorizations and clinical submission. Demonstrates knowledge of reimbursement mechanisms. Considers patient’s financial resources for meeting healthcare needs (insurance reimbursement, managed care plans, entitlement programs, and personal resources).

Participates as an active partner with physicians and interdisciplinary teams, providing education regarding admission decisions including status determinations, financial and clinical outcomes, and documentation requirements and standards.

Maintains current knowledge on all regulatory changes that affect care delivery or reimbursement of acute care services. Uses

knowledge of national and local coverage determinations to appropriately advise physicians.

Identifies system obstacles that affect patient outcomes and consults with interdisciplinary team members to problem solve.

Demonstrates mastery in InterQual level of care guidelines. Possesses proficiency in utilization review systems, clinical support

systems, and business support applications.

Promotes use of evidence-based protocols to influence high quality and cost-effective care.

Escalates clinically and financially complex cases to leadership, offering possible solutions through discussion and feedback. Engages regularly in formal and informal dialogue about quality; directly addressing concerns and promoting continuous improvement.

Performs concurrent reviews and additional duties as assigned.

All roles must demonstrate GBMC Values:

Respect

I will treat everyone with courtesy. I will foster a healing environment.

Treats others with fairness, kindness, and respect for personal dignity and privacy

Listens and responds appropriately to others’ needs, feelings, and capabilities

Excellence

I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.

Meets and/or exceeds customer expectations
Actively pursues learning and self-development
Pays attention to detail; follows through

Accountability

I will be professional in the way I act, look and speak. I will take ownership to solve problems.

Sets a positive, professional example for others
Takes ownership of problems and does what is needed to solve them
Appropriately plans and utilizes required resources for various job duties
Reports to work regularly and on time

Teamwork

I will be engaged and collaborative. I will keep people informed.

Works cooperatively and collaboratively with others for the success of the team
Addresses and resolves conflict in a positive way
Seeks out the ideas of others to reach the best solutions
Acknowledges and celebrates the contribution of others

Ethical Behavior

I will always act with honesty and integrity. I will protect the patient.

Demonstrates honesty, integrity and good judgment
Respects the cultural, psychosocial, and spiritual needs of patients/families/coworkers

Results

I will set goals and measure outcomes that support organizational goals. I will give and accept help to achieve goals.

Embraces change and improvement in the work environment
Continuously seeks to improve the quality of products/services
Displays flexibility in dealing with new situations or obstacles
Achieves results on time by focusing on priorities and manages time efficiently

Pay Range

$66,292.41 - $107,062.33

Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.

Equal Employment Opportunity

GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

Share this job

Related Jobs

Travel

Full-time

Permanent Staff ER RN job in Westminster, MD - Make $50 to $50 per hour

apartment Aya Healthcare location_onWestminster, MD

Access This Permanent Staff ER Registered Nurse Job in Westminster, MD. Job Details Pay: $50.00 to $50.00 per hour. (This info is approximate. To view complete pay and facility information, please log in to your Aya account or register with us now.) Shift: 3, 12-Hour 19:00 - 07:30 Join Aya for the most career options. Aya Healthcare gives you access to the most jobs — and the most exclusive opportunities — in the industry. We have strong relationships with leading facilities nationwide, and job options to support your personal and professional goals. Whether you want to put down roots with a permanent role, explore the country with a travel job or pick up per diem shifts close to home, Aya’s got you covered. Log In Today And Search jobs View pay & facility details Get real-time job notifications Register now to get started.

Full-time

ER Registered Nurse (ER RN Full-time Night Shift)

apartment Emerus location_onNew Freedom, PA

About Us HIGHLIGHTS : Emergency Room Registered Nurse SHIFT: Night Shift (7P- 7A) JOB TYPE: Full-time FACILITY TYPE: 20 bed Small-Format Hospital (10 ER, 10 Inpatient) JOB PERKS: Night/Weekend shift differentials, 401K MATCH (100% vested day ONE after the eligibility period has been met!), Paid Employee Referrals! FREE Parking! We are Emerus, the leader in small-format hospitals. We partner with respected and like-minded health systems who share our mission: To provide the care patients need, in the neighborhoods they live, by teams they trust. Our growing number of amazing partners includes Allegheny Health Network, Ascension, Baptist Health System, Baylor Scott & White Health, ChristianaCare, Dignity Health St. Rose Dominican, The Hospitals of Providence, INTEGRIS Health, MultiCare and WellSpan. Our innovative hospitals are fully accredited and provide highly individualized care. Emerus' commitment to patient care extends far beyond the confines of societal norms. We believe that every individual who walks through our doors deserves compassionate, comprehensive care, regardless of their background, identity, or circumstances. We are committed to fostering a work environment focused on teamwork that celebrates diversity, promotes equity and ensures equal access to information, development and opportunity for all of our Healthcare Pros. Position Overview The purpose of this position is to perform the primary functions of a nurse in assessing, planning, directing, and evaluating patient care in the Emergency Room. Essential Job Functions Plan, prioritize, and provide proficient, age-specific and developmentally/specialty appropriate nursing care by applying advanced specialty clinical nursing knowledge and skills and for ensuring the comfort and safety of patients/families Proficiently and consistently complete accurate, concise and legible documentation on medical records Observe and record signs, symptoms and behaviors including the physiological status of patients Presents proposed revision of interventions and desired outcomes Maintain patient's privacy and confidentiality of information and records at all times Follow physician’s orders in the delivery of nursing care Collect laboratory samples and perform lab testing in accordance with established policies and procedures, as well as COLA and CLIA regulations Adhere to required infection control, isolation procedures and aseptic techniques in the delivery of patient care Perform admission, discharge and transfer procedures Participate in assessing, planning, implementing and evaluating the nursing care given Assemble equipment and supply for various diagnostic or treatment procedures in the specialty service area; performs or assists others with procedures or treatments. Handle care in accordance with legal, hospital/facility, departmental policies and procedures, and established standards of nursing care and practice, as defined by the Board of Nursing of that State Other Job Functions Perform all Quality Assessment activities assigned and document Attend staff meetings or other company sponsored or mandated meetings as required Perform additional duties as assigned Basic Qualifications Associate’s Degree or Nursing Diploma, required; BSN, preferred Current state licensure as a Registered Nurse without sanctions, required 2+ years full-time RN experience in ER or other comparable experience, required Current BLS, ACLS/ALS, and PALS certifications from the American Heart Association or the American Red Cross, required; ENPC certification from ENA may be substituted for PALS certification; TNCC preferred. Position requires fluency in English; written and oral communication Pennsylvania Candidates : Act 33 (Child Abuse History Clearance), & Act 73 (FBI Fingerprint Criminal History Clearance) completed within the last 5 years, or must be obtained prior to start date.

Full-time

ER Registered Nurse (FT SWING 11-11 or 3-3)

apartment Emerus location_onNew Freedom, PA

About Us We are Emerus, the leader in small-format hospitals. We partner with respected and like-minded health systems who share our mission: To provide the care patients need, in the neighborhoods they live, by teams they trust. Our growing number of amazing partners includes Allegheny Health Network, Ascension, Baptist Health System, Baylor Scott & White Health, ChristianaCare, Dignity Health St. Rose Dominican, The Hospitals of Providence, INTEGRIS Health, MultiCare and WellSpan. Our innovative hospitals are fully accredited and provide highly individualized care. Emerus' commitment to patient care extends far beyond the confines of societal norms. We believe that every individual who walks through our doors deserves compassionate, comprehensive care, regardless of their background, identity, or circumstances. We are committed to fostering a work environment focused on teamwork that celebrates diversity, promotes equity and ensures equal access to information, development and opportunity for all of our Healthcare Pros. Position Overview The purpose of this position is to perform the primary functions of a nurse in assessing, planning, directing, and evaluating patient care in the Emergency Room. Essential Job Functions Plan, prioritize, and provide proficient, age-specific and developmentally/specialty appropriate nursing care by applying advanced specialty clinical nursing knowledge and skills and for ensuring the comfort and safety of patients/families Proficiently and consistently complete accurate, concise and legible documentation on medical records Observe and record signs, symptoms and behaviors including the physiological status of patients Presents proposed revision of interventions and desired outcomes Maintain patient's privacy and confidentiality of information and records at all times Follow physician’s orders in the delivery of nursing care Collect laboratory samples and perform lab testing in accordance with established policies and procedures, as well as COLA and CLIA regulations Adhere to required infection control, isolation procedures and aseptic techniques in the delivery of patient care Perform admission, discharge and transfer procedures Participate in assessing, planning, implementing and evaluating the nursing care given Assemble equipment and supply for various diagnostic or treatment procedures in the specialty service area; performs or assists others with procedures or treatments. Handle care in accordance with legal, hospital/facility, departmental policies and procedures, and established standards of nursing care and practice, as defined by the Board of Nursing of that State Other Job Functions Perform all Quality Assessment activities assigned and document Attend staff meetings or other company sponsored or mandated meetings as required Perform additional duties as assigned Basic Qualifications Associate’s Degree, required; BSN, preferred Current state licensure as a Registered Nurse without sanctions, required 2+ years full-time RN experience in ER or other comparable experience, required Current BLS, ACLS, and PALS certifications from the American Heart Association, required; ENPC certification from ENA may be substituted for PALS certification; TNCC preferred Position requires fluency in English; written and oral communication Pennsylvania Candidates : Act 33 (Child Abuse History Clearance), & Act 73 (FBI Fingerprint Criminal History Clearance) completed within the last 5 years, or must be obtained prior to start date.

Full-time

ER Registered Nurse (ER Nurse Full-time Day Shift)

apartment Emerus location_onNew Freedom, PA

About Us HIGHLIGHTS : Emergency Room Registered Nurse SHIFT: Day Shift (7A- 7P) JOB TYPE: Full-time FACILITY TYPE: 20 bed Small-Format Hospital (10 ER, 10 Inpatient) JOB PERKS: Night/Weekend shift differentials, 401K MATCH (100% vested day ONE after the eligibility period has been met!), Paid Employee Referrals! FREE Parking! We are Emerus, the leader in small-format hospitals. We partner with respected and like-minded health systems who share our mission: To provide the care patients need, in the neighborhoods they live, by teams they trust. Our growing number of amazing partners includes Allegheny Health Network, Ascension, Baptist Health System, Baylor Scott & White Health, ChristianaCare, Dignity Health St. Rose Dominican, The Hospitals of Providence, INTEGRIS Health, MultiCare and WellSpan. Our innovative hospitals are fully accredited and provide highly individualized care. Emerus' commitment to patient care extends far beyond the confines of societal norms. We believe that every individual who walks through our doors deserves compassionate, comprehensive care, regardless of their background, identity, or circumstances. We are committed to fostering a work environment focused on teamwork that celebrates diversity, promotes equity and ensures equal access to information, development and opportunity for all of our Healthcare Pros. Position Overview The purpose of this position is to perform the primary functions of a nurse in assessing, planning, directing, and evaluating patient care in the Emergency Room. Essential Job Functions Plan, prioritize, and provide proficient, age-specific and developmentally/specialty appropriate nursing care by applying advanced specialty clinical nursing knowledge and skills and for ensuring the comfort and safety of patients/families Proficiently and consistently complete accurate, concise and legible documentation on medical records Observe and record signs, symptoms and behaviors including the physiological status of patients Presents proposed revision of interventions and desired outcomes Maintain patient's privacy and confidentiality of information and records at all times Follow physician’s orders in the delivery of nursing care Collect laboratory samples and perform lab testing in accordance with established policies and procedures, as well as COLA and CLIA regulations Adhere to required infection control, isolation procedures and aseptic techniques in the delivery of patient care Perform admission, discharge and transfer procedures Participate in assessing, planning, implementing and evaluating the nursing care given Assemble equipment and supply for various diagnostic or treatment procedures in the specialty service area; performs or assists others with procedures or treatments. Handle care in accordance with legal, hospital/facility, departmental policies and procedures, and established standards of nursing care and practice, as defined by the Board of Nursing of that State Other Job Functions Perform all Quality Assessment activities assigned and document Attend staff meetings or other company sponsored or mandated meetings as required Perform additional duties as assigned Basic Qualifications Associate’s Degree, required; BSN, preferred Current state licensure as a Registered Nurse without sanctions, required 2+ years full-time RN experience in ER or other comparable experience, required Current BLS, ACLS, and PALS certifications from the American Heart Association, required; ENPC certification from ENA may be substituted for PALS certification; TNCC preferred Position requires fluency in English; written and oral communication

Full-time

ER Registered Nurse (ER RN Full-time Nights)

apartment Emerus location_onNew Freedom, PA

About Us HIGHLIGHTS : Emergency Room Registered Nurse SHIFT: Night Shift (7P- 7A) JOB TYPE: Full-time FACILITY TYPE: 20 bed Small-Format Hospital (10 ER, 10 Inpatient) JOB PERKS: Night/Weekend shift differentials, 401K MATCH (100% vested day ONE after the eligibility period has been met!), Paid Employee Referrals! FREE Parking! We are Emerus, the leader in small-format hospitals. We partner with respected and like-minded health systems who share our mission: To provide the care patients need, in the neighborhoods they live, by teams they trust. Our growing number of amazing partners includes Allegheny Health Network, Ascension, Baptist Health System, Baylor Scott & White Health, ChristianaCare, Dignity Health St. Rose Dominican, The Hospitals of Providence, INTEGRIS Health, MultiCare and WellSpan. Our innovative hospitals are fully accredited and provide highly individualized care. Emerus' commitment to patient care extends far beyond the confines of societal norms. We believe that every individual who walks through our doors deserves compassionate, comprehensive care, regardless of their background, identity, or circumstances. We are committed to fostering a work environment focused on teamwork that celebrates diversity, promotes equity and ensures equal access to information, development and opportunity for all of our Healthcare Pros. Position Overview The purpose of this position is to perform the primary functions of a nurse in assessing, planning, directing, and evaluating patient care in the Emergency Room. Essential Job Functions Plan, prioritize, and provide proficient, age-specific and developmentally/specialty appropriate nursing care by applying advanced specialty clinical nursing knowledge and skills and for ensuring the comfort and safety of patients/families Proficiently and consistently complete accurate, concise and legible documentation on medical records Observe and record signs, symptoms and behaviors including the physiological status of patients Presents proposed revision of interventions and desired outcomes Maintain patient's privacy and confidentiality of information and records at all times Follow physician’s orders in the delivery of nursing care Collect laboratory samples and perform lab testing in accordance with established policies and procedures, as well as COLA and CLIA regulations Adhere to required infection control, isolation procedures and aseptic techniques in the delivery of patient care Perform admission, discharge and transfer procedures Participate in assessing, planning, implementing and evaluating the nursing care given Assemble equipment and supply for various diagnostic or treatment procedures in the specialty service area; performs or assists others with procedures or treatments. Handle care in accordance with legal, hospital/facility, departmental policies and procedures, and established standards of nursing care and practice, as defined by the Board of Nursing of that State Other Job Functions Perform all Quality Assessment activities assigned and document Attend staff meetings or other company sponsored or mandated meetings as required Perform additional duties as assigned Basic Qualifications Associate’s Degree, required; BSN, preferred Current state licensure as a Registered Nurse without sanctions, required 2+ years full-time RN experience in ER or other comparable experience, required Current BLS, ACLS, and PALS certifications from the American Heart Association, required; ENPC certification from ENA may be substituted for PALS certification; TNCC preferred Position requires fluency in English; written and oral communication