Case Management / Utilization Review Nurse

  • Jai Medical Systems Managed Care Organization, Inc.
  • Cockeysville, MD, USA
  • Nov 21, 2021

Job Description

Jai Medical Systems Managed Care Organization, Inc. was founded in 1997 and serves a diverse population of children and adults throughout the State of Maryland.

Since our founding, Jai Medical Systems' mission has been to provide high quality healthcare benefits and services to the people of Maryland. We continue this tradition of quality and excellence by working with our members to help identify their healthcare needs, while remaining an active and positive presence within our communities.

Throughout our history of service, Jai Medical Systems has been consistently ranked by the State of Maryland as one of the highest rated Managed Care Organizations for quality*. Jai Medical Systems' commitment to our members and high quality healthcare is demonstrated by our performance in health insurance quality measures, such as HEDIS®**. In fact, our HEDIS® scores for key healthcare quality indicators, such as Well Child Checks, Cervical Cancer Screenings, and Diabetes Care, are among some of the highest HEDIS® scores in the nation.

*According to the State of Maryland's Value-Based Purchasing Initiative.

**HEDIS® (Healthcare Effectiveness Data and Information Set) is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA).

Position Overview:

We are currently seeking a full-time, licensed registered nurse for case management and utilization review. Prior CM/UR experience preferred, but not necessary.

Perform telephonic reviews for enrollees across the service continuum (pre-certification/authorization, concurrent and retrospective reviews) utilizing InterQual criteria to monitor providers to ensure the quality, quantity, timeliness and effectiveness of service. Perform case management/complex case management on identified members in order to increase compliance and help with coordination of care.

Requirements:

  • Current valid Registered Nurse license in the state of Maryland
  • Bachelor's degree, preferred
  • Minimum of 2 years' experience as an RN, with at least one year in a hospital setting
  • InterQual experience preferred
  • CPR certified
  • Proficient in Microsoft Office
  • Strong organizational skills and communication skills
  • Ability to prioritize and manage multiple priorities
  • Strong work ethic and ability to be flexible
  • Independent worker, but able to work well in a team
  • Ability to type a minimum of 35 WPM, preferred
  • Required in-office hours of Monday through Friday; 9 AM to 6 PM

Job Type: Full-time

Pay: From $72,000.00 per year

Benefits:

  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Disability insurance
  • Employee assistance program
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance

Physical Setting:

  • Office

Schedule:

  • Monday to Friday

Supplemental Pay:

  • Bonus pay

Application Question(s):

  • Are you available to work required in office hours Monday-Friday 9am-6pm (1 hour lunch)?

Education:

  • Bachelor's (Preferred)

License/Certification:

  • RN (Required)

Work Location: One location