Utilization Review Nurse - job 1 of 2

As a Utilization Review Nurse at University of Maryland St. Joseph Medical Center, your primary responsibilities include coordinating care for selected patient populations, collaborating with physicians and healthcare professionals, and overseeing case management processes. You will assess patient needs, plan and implement care strategies, and monitor effectiveness to ensure that patients receive top-notch care while optimizing resources. Additionally, your role involves engaging with outside agencies and insurance carriers to facilitate patient services and guarantee accurate reimbursement for our hospital.

To qualify as a Utilization Review Nurse at University of Maryland St. Joseph Medical Center, candidates should hold at least an Associate’s Degree in nursing and possess a State Registered Nurse License. Preferred qualifications include a Bachelor’s Degree, CCM Case Management Certification, and relevant experience in case management or healthcare reimbursement systems. Experience in acute care hospitals is also highly valued, with 2-4 years in case management being preferred.

Essential skills for a Utilization Review Nurse at University of Maryland St. Joseph Medical Center include strong verbal and written communication abilities, excellent interpersonal skills, and a firm grasp of medical terminology. Additionally, being familiar with healthcare reimbursement systems and having problem-solving skills are crucial for effectively coordinating care and advocating for patients' needs.

The patient care process for a Utilization Review Nurse at University of Maryland St. Joseph Medical Center involves planning care needs in collaboration with patients, families, and healthcare staff. This includes overseeing the implementation of transition plans, monitoring patient progress, and ensuring effective communication with everyone involved. The goal is to facilitate not only quality patient outcomes but also a smooth continuum of care throughout their treatment journey.

The compensation range for a Utilization Review Nurse at University of Maryland St. Joseph Medical Center is between $39.52 and $50.65 per hour. In addition to a competitive salary, employees are also entitled to comprehensive benefits, as detailed in the UMMS Benefits Guide, ensuring that our team feels valued and supported in their healthcare career.

When discussing your experience with case management, highlight specific scenarios where you effectively assessed patient needs and coordinated care. Be sure to mention any collaborative efforts with interdisciplinary teams that led to improved patient outcomes, and share metrics that demonstrate your ability to manage resources efficiently.

To guarantee compliance with medical documentation standards, emphasize your understanding of legal mandates regarding patient confidentiality and the protocols for documenting actions and interventions in medical records. Discuss how you’ve monitored documentation practices and engaged in regular training to stay updated with the necessary guidelines.

In response to a challenging patient case, detail a situation where you faced obstacles in care coordination, and explain how you addressed the challenges by collaborating with other healthcare professionals and advocating for the patient's needs. Highlight the outcomes and lessons learned from that experience.

Discuss your approach to effective communication, emphasizing active listening, empathy, and ensuring that you provide information in an easily understandable manner. You could also mention using teach-back methods to confirm understanding and build rapport with patients and families.

When asked about prioritizing tasks, explain your process for assessing the urgency and importance of patient needs, while also balancing collaboration with healthcare teams. Share specific tools or techniques you employ to stay organized, manage timelines, and ensure quality care is consistently maintained.

When discussing your familiarity with healthcare reimbursement systems, outline your experience with various payers and reimbursement methodologies. Talk about how you’ve navigated these systems to secure appropriate services for patients and facilitated communications with insurance carriers.

In your response, highlight your awareness of technology's impact on utilization review processes, from electronic health records to data analytics. Discuss how you've utilized technology to streamline patient care, track outcomes, or enhance communication across teams.

For complex cases, emphasize your analytical skills and ability to assess situations from multiple angles. Discuss specific examples where you identified issues and proposed solutions, working collaboratively with teams to enact changes that improved patient outcomes.

Clarify how interdisciplinary collaboration is critical in your role as a Utilization Review Nurse, as it ensures comprehensive care for patients. Speak to your experiences building relationships with healthcare professionals and how it has positively influenced patient care and outcomes.

Share your passion for patient advocacy and improving healthcare efficiency. Discuss what drew you to this specialty and how your personal values align with the mission of organizations like University of Maryland St. Joseph Medical Center, focusing on delivering high-quality care.