Top 91 Utilization review Jobs in Baltimore Md

Utilization Review Nurse (Registered Nurse CI)
State of Maryland - MDH Education and Training —Catonsville, MD
- $87,253 - $137,603 a year
- Online Application
- Hybrid work
- RN License
- Residential
- Entry level
7d
Utilization Review Nurse - Managed Care
Johns Hopkins Health Plans —Hanover, MD
- $39.64 - $61.45 an hour
- Full-time
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
4d
HIM Clinical Document Specialist, UMMC
University of Maryland Medical System —Baltimore, MD
- Full-time
- Medicine
- RN License
- Inpatient
Clinical Analyst
Global Alliant Inc —Baltimore, MD
- Full-time
- Remote
- Mid-level
- Computer skills
- Communication skills
Quick Apply
7d
HIM Clinical Document Specialist, Hybrid
University of Maryland Medical System —Bel Air, MD
- $38.67 - $58.05 an hour
- Full-time
- Nursing
- Senior level
- Associate's degree
Insurance Follow Up Specialist
UR SOLUTIONS —Towson, MD
- Full-time
- HIPAA
- Mid-level
- Office
Clinical Medical Review Nurse (Remote)
CareFirst BlueCross BlueShield —Baltimore, MD
- $67,320 - $133,705 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- RN License
- 401(k)
Quick Apply
1d
Care Manager (Remote)
CareFirst BlueCross BlueShield —Baltimore, MD
- $72,360 - $143,715 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- RN License
- 401(k)
Quick Apply
Revenue Cycle Coordinator I- Collections
Johns Hopkins Health System —Baltimore, MD
- Full-time
- Hospital
- Mid-level
- High school diploma or GED
Nurse Auditor
David-James —Baltimore, MD
- $75,000 - $85,000 a year
- Full-time
- Hybrid work
- 5 years
- Mid-level
- Older adults
- Continuing education credits
- Health insurance
DIRECTOR HEALTH INFORMATION MANAGEMENT
MT WASHINGTON PEDIATRIC HOSPITAL —Baltimore, MD
- $48.52 - $61.86 an hour
- Full-time
- Hospital
- Bachelor of Science
- Computer skills
Quick Apply
Utilization Assistant - Acute
Highland Hospital —Annapolis, MD
- Full-time
- Acute care
- Hospital
- Research
Quick Apply
2d
Case Manager
Mercy Medical Center —Baltimore, MD
- $36.92 - $66.46 an hour
- Full-time
- Nursing
- RN License
- Hospital
- 403(b) matching
- Paid holidays
13d
Patient Accounts Coordinator - Auth and Elig Specialist
Gilchrist Hospice Care, Inc. —Hunt Valley, MD
- $19.92 - $29.87 an hour
- Full-time
- Mid-level
- High school diploma or GED
- Organizational skills
Quick Apply
Medical Review Nurse III
RELI GROUP INC —Baltimore, MD
- $80,000 - $95,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
Clinical Support Supervisor (Hybrid)
CareFirst BlueCross BlueShield —Baltimore, MD
- $62,280 - $128,453 a year
- Full-time
- Bilingual
- Microsoft Excel
- Mid-level
- 401(k)
Quick Apply
Utilization Management CoordinatorNE
University of Maryland Medical System —Glen Burnie, MD
- $40.61 - $60.96 an hour
- Full-time
- Nursing
- RN License
- Hospital
9d
Senior Consultant - Clinical Documentation Specialist
Deloitte —Baltimore, MD
- $110,700 - $218,300 a year
- Full-time
- Microsoft Word
- Nursing
- RN License
Telephonic Case Manager I
CorVel Corporation —Nottingham, MD
- $63,739 - $95,264 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
Quick Apply
Clinical Pharmacist - Clinical Consulting & Utilization Review (Hybrid)
CareFirst BlueCross BlueShield —Baltimore, MD
- $120,240 - $214,929 a year
- Full-time
- Travel
- US work authorization
- Organizational skills
- 401(k)
Quick Apply

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Utilization Review Nurse (Registered Nurse CI)

State of Maryland - MDH Education and Training
Catonsville, MD

Apply Now

Job Details

Full-time
$87,253 - $137,603 a year
7 days ago

Qualifications

RN License

Full Job Description

GRADE

LOCATION OF POSITION

MDH, Maryland Healthcare System, 55 Wade Ave, Catonsville, MD

Main Purpose of Job

This position is responsible for conducting reviews on admissions, continued stays, and readmissions, as well as managing the denial process. This position is vital to addressing the Maryland Department of Health (MDH) waitlist by identifying patients who no longer meet medical necessity criteria for inpatient care. These reviews are conducted independently of treatment teams to provide objective feedback to hospitals regarding patient progress. This position also manages the appeal process, working with the Physician Advisor when patients do not meet medical necessity criteria. Cases are presented to the Utilization Review to recommend the committee to determine if a second Physician Advisor review is required. This is a hybrid position that allows for teleworking. This position provides reports that identify opportunities to improve care through medical record reviews. These improvements may include the adequacy of documentation regarding patient progress, missing or insufficient records, the absence of required assessments, and the overall quality of treatment.

MINIMUM QUALIFICATIONS

Education: Determined by the Maryland State Board of Nursing under the licensing requirements for Registered Nurses.

Experience: None.

DESIRED OR PREFERRED QUALIFICATIONS

The desired candidate should possess the following:

Experience using Google Suites (especially Google Sheets) to complete NRI statistics and maintain utilization review files and the UR database
Experience in Risk Management

LICENSES, REGISTRATIONS AND CERTIFICATIONS

1. Candidates for positions in this classification must possess a current license as a Registered Nurse from the Maryland State Board of Nursing, 4140 Patterson Avenue, Baltimore, Maryland 21215 or possess a current multi-state license in party states that candidates have declared as primary states of residence.

2. Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operator’s license valid in the State of Maryland.

3. Employees in this classification may be required to successfully complete and maintain current certification of cardiopulmonary resuscitation training.

SPECIAL REQUIREMENTS

1. Employees in this classification are subject to call-in and, therefore, will be required to provide the facility with a phone number at which they can be reached.

2. Employees in this classification are subject to substance abuse testing in accordance with Code of Maryland Regulations 17.04.09, Testing for Illegal Use of Drugs.

SELECTION PROCESS

Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position. Therefore, it is essential that you provide complete and accurate information on your application. Please report all related education, experience, dates and hours of work. Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview).

Complete applications must be submitted by the closing date. Information submitted after this date will not be added.

Incorrect application forms will not be accepted. Resumes will not be accepted in lieu of a completed application.

Candidates may remain on the certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

BENEFITS

STATE OF MARYLAND BENEFITS

FURTHER INSTRUCTIONS

Online applications are highly recommended. However, if you are unable to apply online, the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201. Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.

If additional information is required, the preferred method is to upload. If you are unable to upload, please fax the requested information to 410-333-5689. Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time.

For questions regarding this recruitment, please contact the MDH Recruitment and Selection Division at 410-767-1251.

If you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at 410-767-4850 or [email protected].

Appropriate accommodations for individuals with disabilities are available upon request by calling: 410-767-1251 or MD TTY Relay Service 1-800-735-2258.

We thank our Veterans for their service to our country.

People with disabilities and bilingual candidates are encouraged to apply.

As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.

Apply Now

Refine Your Search

utilization review jobs in baltimore md

Utilization Review Nurse (Registered Nurse CI)

Utilization Review Nurse - Managed Care

HIM Clinical Document Specialist, UMMC

Clinical Analyst

HIM Clinical Document Specialist, Hybrid

Insurance Follow Up Specialist

Clinical Medical Review Nurse (Remote)

Care Manager (Remote)

Revenue Cycle Coordinator I- Collections

Nurse Auditor

DIRECTOR HEALTH INFORMATION MANAGEMENT

Utilization Assistant - Acute

Case Manager

Patient Accounts Coordinator - Auth and Elig Specialist

Medical Review Nurse III

Clinical Support Supervisor (Hybrid)

Utilization Management CoordinatorNE

Senior Consultant - Clinical Documentation Specialist

Telephonic Case Manager I

Clinical Pharmacist - Clinical Consulting & Utilization Review (Hybrid)