13 utilization review nurse rn jobs found in Baltimore, MD

Summary: The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of payment. Interfaces with 3rd party payers by providing pertinent, relevant clinical information. Responsibilities Include: Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource consumption. Enters clinical reviews into the software program. Maintains close communication with external reviewers/internal financial counselors/patient access personnel and performs certification activities as required by payor. Monitors and identifies patterns or trends in utilization management. Monitors potential and actual denials and coordinates with nurse Care Manager and/or Social Worker for any follow up necessary. Documents in software program the actions taken to coordinate care and avoid...

Work Schedule: This is an EVERY Saturday and Sunday role Summary: The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of payment. Interfaces with 3rd party payers by providing pertinent, relevant clinical information. Responsibilities Include: Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource consumption. Enters clinical reviews into the software program. Maintains close communication with external reviewers/internal financial counselors/patient access personnel and performs certification activities as required by payor. Monitors and identifies patterns or trends in utilization management. Monitors potential and actual denials and coordinates with nurse Care Manager and/or Social Worker for any follow up necessary. Documents in...

LifeBridge Health, Inc. seeks a Utilization Review Nurse RN to evaluate medical necessity, level of care, and length of stay for hospitalized and ambulatory patients. The nurse reviews clinical documentation using InterQual/MCG and payer guidelines, collaborates with physicians and care teams, and communicates with insurers to obtain authorizations and prevent denials. Responsibilities include concurrent and retrospective review, documentation clarification, and escalation of complex cases. The role supports safe, cost-effective care, regulatory compliance, and optimal patient outcomes in a mission-driven, community-focused health system with strong opportunities for growth.

Sinai Hospital's Utilization Review operates as a distinct specialty service line of physician advisors, nurses, and support staff who ensure hospital stays are clinically appropriate and fully covered by the patient's insurance. The team focuses on appropriate resource use, operational efficiency, and timely patient services while maintaining or improving quality of care. About the Role/Unit: The PRN Utilization Review RN at Sinai Hospital works with stakeholders in the Revenue Cycle Management process and payors to ensure efficiency of utilization of resources, minimize losses and maximize reimbursement. *This PRN position supports the ED and will be scheduled based on the needs of the dept.* Key Responsibilities: Medical necessity review of patient stays and referral to the physician advisor as needed Denial Management, including coordination with Case Management Monitor utilization of hospital resources Requirements: Education: BSN preferred; ADN...

Sinai Hospital's inpatient Care Management team provides discharge planning, transitional care coordination, complex care management, and utilization review through a multidisciplinary team of registered nurses, LPNs, licensed social workers, and administrative staff. While many functions are dictated by regulatory requirements, the core clinical focus is always on ensuring a safe and effective transition to the next appropriate level of care. Your work directly supports safe discharge planning, reduces barriers to care, and improves patient outcomes. About the Role: The Inpatient RN Case Manager at Sinai Hospital works with the clinical team and medical provider to coordinate and implement safe discharge plans for patients. Their main goals are to improve patient well-being, outcomes, and ensure healthcare services are used efficiently and timely. Key Responsibilities: Assessment & Planning: Conducts initial and ongoing assessments to determine patient needs for...

Summary: *Applicants must have UR Experience* The ED Case Manager (UR) is responsible for the timely review of patients to make a recommendation of status for those patients the provider feels need to stay. Further, to make recommendations for discharge where appropriate and including services the patient may need for success in the community. The Inpatient Care Manager, in collaboration with the clinical team and medical provider, provides discharge planning coordination and intervention. The Care Manger strives to promote patient wellness, improved care outcomes, efficient utilization of health services and minimize denials of payment among a patient population with complex health needs. REQUIREMENTS: Basic professional knowledge; equivalent to a Bachelor's degree; working knowledge of theory and practice within a specialized field. BSN required from CCNE accredited schools. This requirement will be lifted for LBH candidates employed as a Utilization Review...

Summary: Work Schedule: This role requires 5/8's one week and 4/8's the following week JOB SUMMARY: The Inpatient Care Manager, in collaboration with the clinical team and medical provider, provides discharge planning coordination and intervention. The Care Manger strives to promote patient wellness, improved care outcomes, efficient utilization of health services and minimize denials of payment among a patient population with complex health needs. REQUIREMENTS: Basic professional knowledge; equivalent to a Bachelor's degree; working knowledge of theory and practice within a specialized field. BSN required from CCNE accredited schools. This requirement will be lifted for LBH candidates employed as a Utilization Review Nurse, Clinical Care Coordinator, Patient Care Integrator or RN Case Manager. Credentials: Essential: Registered Nurse License Experience: Essential: 5-7 years Pay Range: $40.12 to $62.19 Based On Experience Benefits: Medical,...

Summary: This role requires 5/8's one week and 4/8's the following week The Case Manager, in collaboration with the clinical team and medical provider, provides discharge planning coordination and intervention. The Care Manager strives to promote patient wellness, improved care outcomes, efficient utilization of health services and minimize denials of payment among a patient population with complex health needs. REQUIREMENTS: Basic professional knowledge; equivalent to a Bachelor's degree; working knowledge of theory and practice within a specialized field. BSN required from CCNE accredited schools. This requirement will be lifted for LBH candidates employed as a Utilization Review Nurse, Clinical Care Coordinator, Patient Care Integrator or RN Case Manager. Essential: Registered Nurse License Experience: Essential: 5-7 years Pay Range: $40.12 to $62.19 Based On Experience Benefits: Medical, dental, and vision coverage starting the first of the month...

Summary: Work Schedule: This is a remote role that requires every Saturday and Sunday commitment. JOB SUMMARY: The Inpatient Care Manager, in collaboration with the clinical team and medical provider, provides discharge planning coordination and intervention. The Care Manger strives to promote patient wellness, improved care outcomes, efficient utilization of health services and minimize denials of payment among a patient population with complex health needs. REQUIREMENTS: Basic professional knowledge; equivalent to a Bachelor's degree; working knowledge of theory and practice within a specialized field. BSN required from CCNE accredited schools. This requirement will be lifted for LBH candidates employed as a Utilization Review Nurse, Clinical Care Coordinator, Patient Care Integrator or RN Case Manager. Credentials: Essential: Registered Nurse License Experience: Essential: 5-7 years Pay Range: $40.12 to $62.19 Based On Experience Benefits:...

About this Job: General Summary of Position The Assistant Director of Nursing is a member of MedStar Health entity-based Division of Nursing and leadership team. Supports and collaborates with the Director of Nursing in providing leadership and oversight for a specific unit/department. Directs and coordinates the nursing and patient care delivery of the unit-based professional and support personnel. Ensures the provision of holistic culturally competent and person-centered quality safe and cost-effective evidence-based nursing care for patients/families. Applies the nursing process within the context of the organization's shared/collaborative decision-making framework. Collaboratively manages the patient's transitions across the continuum of care to assist patients and populations in achieving or maintaining an optimal level of health and functioning.The Assistant Director of Nursing assumes administrative and leadership authority and responsibility on a 24 hours/7 days per week...

About this Job: General Summary of Position The Assistant Director of Nursing is a member of MedStar Health entity-based Division of Nursing and leadership team. Supports and collaborates with the Director of Nursing in providing leadership and oversight for a specific unit/department. Directs and coordinates the nursing and patient care delivery of the unit-based professional and support personnel. Ensures the provision of holistic culturally competent and person-centered quality safe and cost-effective evidence-based nursing care for patients/families. Applies the nursing process within the context of the organization's shared/collaborative decision-making framework. Collaboratively manages the patient's transitions across the continuum of care to assist patients and populations in achieving or maintaining an optimal level of health and funThe Assistant Director of Nursing assumes administrative and leadership authority and responsibility on a 24 hours/7 days per week basis for...

About this Job: General Summary of Position The Assistant Director of Nursing is a member of MedStar Health entity-based Division of Nursing and leadership team. Supports and collaborates with the Director of Nursing in providing leadership and oversight for a specific unit/department. Directs and coordinates the nursing and patient care delivery of the unit-based professional and support personnel. Ensures the provision of holistic culturally competent and person-centered quality safe and cost-effective evidence-based nursing care for patients/families. Applies the nursing process within the context of the organization's shared/collaborative decision-making framework. Collaboratively manages the patient's transitions across the continuum of care to assist patients and populations in achieving or maintaining an optimal level of health and functioning.The Assistant Director of Nursing assumes administrative and leadership authority and responsibility on a 24 hours/7 days per week...

About this Job: General Summary of Position The Assistant Director of Nursing is a member of MedStar Health entity-based Division of Nursing and leadership team. Supports and collaborates with the Director of Nursing in providing leadership and oversight for a specific unit/department. Directs and coordinates the nursing and patient care delivery of the unit-based professional and support personnel. Ensures the provision of holistic culturally competent and person-centered quality safe and cost-effective evidence-based nursing care for patients/families. Applies the nursing process within the context of the organization's shared/collaborative decision-making framework. Collaboratively manages the patient's transitions across the continuum of care to assist patients and populations in achieving or maintaining an optimal level of health and functioning.The Assistant Director of Nursing assumes administrative and leadership authority and responsibility on a 24 hours/7 days per week...