Summary: 

This position is responsible for the planning, development, organization and evaluation of functions for concurrent review programs. Concurrent review is one of the processes within medical management to evaluate while a member is hospitalized the medical necessity of the admission and the appropriateness of the services provided. The process is intended to reduce occurrences of over-under- or misuse of services to improve the member’s inpatient care outcomes and to ensure the cost-effectiveness of the services.

About Maryland Care Management, Inc. (MCMI)

Maryland Care Management, Inc. (MCMI) manages 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, and we are proud of our footprint in the community. With over 230,000 members, MPC consistently has been one of MD’s largest Medicaid-managed care organizations.

Why join us?

MCMI recognizes the importance of flexibility and offers multiple work arrangements. Along with competitive pay, we offer excellent benefits (medical, dental, and vision plans, 100% employer Term Life Insurance, Short and Long-Term Disability, 401k Employer Match up to 4%) as well as 20 days of PTO, and tuition assistance/professional development plans.

Your future colleagues at MCMI are welcoming, friendly, and eager to help each other succeed. We are committed to Diversity, Equity, and Inclusion, providing organizational-wide social opportunities, and constantly improving our ongoing efforts to positively impact our members’ lives.

  What You’ll Do: 

• Recruit and select appropriate staff[VH1]  and prepare timely employee performance evaluations.
• Provide oversight of the concurrent review process.
• Promote individual and team development.
• Prepare reports of utilization indicators and activities for committees and senior management.
• Collaborate with the Director of UM on the development of annual budget.
• Collaborate with interdisciplinary teams and Providers to support staff in coordination of discharge planning and care activities.
• Serve as an active participant in clinical committees.
• Assist in the annual development of measurable goals for inpatient utilization review programs.
• Oversee Skilled Nursing Facility disenrollment process.

Secondary  Functions:

• Promote improved customer service to staff and recognize their improvement efforts.
• Responsible for the development, implementation, and annual review of concurrent review policies and desktops.

Knowledge and Skills:

• Demonstrated skills for presentations and training before small and large groups.
• Knowledge of local health care delivery system.
• Proven Microsoft Office Experience

Education and Work Experience:

• Current state RN license
• Bachelor of Science in Nursing or Health Care Administration and/or health-related field (BSN preferred).
• Master’s or MBA preferred.
• Three to five years of progressively responsible healthcare administrative experience in a managed care setting.
  • Minimum of two years of management and supervisory experience.
  • Minimum of three years of clinical UM experience.

EEOC Statement: ­­­

Following applicable federal, state, and local laws, MCMI prohibits discrimination in employment based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, or any other characteristic protected by law. This commitment extends to all aspects of employment, including hiring, promotion, compensation, benefits, training, social and recreational programs, and all other conditions and privileges of employment.

As a healthcare organization, we recognize the vital importance of inclusivity in delivering quality care to our patients. We strive to foster an environment where individuals of all backgrounds feel respected, valued, and supported. We aim to better comprehend the unique needs of our patients and provide healthcare services that are culturally competent and sensitive.

We encourage candidates from all backgrounds to apply and join us in our mission to provide compassionate and inclusive healthcare. We believe that a diverse workforce enriches our organization and allows us to better understand, connect with, and serve our diverse patient population.