Utilization Management Specialist II , Part-Time, Weekends at University of Maryland Medical System in Baltimore, Maryland

Job Description:

Job Description
We are seeking a detail-oriented Utilization Management Specialist II to join our healthcare team in Baltimore. In this role, you will be responsible for reviewing and evaluating healthcare services to ensure appropriate utilization of medical resources while maintaining quality patient care standards.

• Review and evaluate medical necessity of healthcare services using established criteria and guidelines


• Analyze clinical documentation to determine appropriate levels of care and length of stay


• Collaborate with healthcare providers to ensure optimal patient care delivery


• Process and review authorization requests for medical procedures and treatments


• Monitor and track utilization patterns to identify trends and opportunities for improvement


• Maintain accurate documentation of all case reviews and decisions


• Participate in quality improvement initiatives and care management meetings


• Ensure compliance with federal, state, and organizational healthcare regulations


• Serve as a liaison between providers, patients, and insurance companies


• Generate and analyze utilization reports to support decision-making processes

Company Description
When we say "our community" we mean it.

UMMC Midtown Campus, one of two campuses of the University of Maryland Medical Center, has had a long history of working to keep our community healthy and has grown to become a trusted teaching hospital for medical and surgical care in Baltimore City.

Located in Baltimore's cultural center near the historic Mount Vernon neighborhood, UMMC Midtown Campus is a 180-bed, community teaching hospital with a focus on helping people manage chronic diseases, including diabetes, hypertension, pulmonary conditions, and infectious diseases.


Qualifications

• Bachelor's degree in Healthcare Administration, Nursing, or related field


• 3-5 years of experience in healthcare utilization management


• Strong knowledge of medical terminology, clinical guidelines, and healthcare regulations


• Proficiency in electronic health record (EHR) systems and case management software


• Experience with medical necessity reviews and claims processing


• Advanced analytical and problem-solving skills


• Excellent organizational and time management abilities


• Strong written and verbal communication skills


• Proficiency in Microsoft Office Suite


• Current RN license preferred


• Utilization Review Certification is a plus


• Comprehensive understanding of healthcare insurance policies and procedures


• Knowledge of medical coding and billing practices


• Familiarity with Maryland state healthcare regulations

Additional Information
All your information will be kept confidential according to EEO guidelines.



Compensation:



Pay Range: $34.01 - $47.18


Other Compensation (if applicable):


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