Top 48 Utilization review nurse Jobs in Maryland

RN Team Lead Utilization Review
MedStar Health —Clinton, MD
- $89,065 - $162,801 a year
- Full-time
- Hybrid work
- Nursing
- RN License
- Hospital
Quick Apply
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
4d
Utilization Reviewer
University of Maryland Medical System —Largo, MD
- $40.61 - $60.96 an hour
- Full-time
- Nursing
- RN License
- Hospital
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
4d
Clinical Quality Nurse (RN)
Johns Hopkins Health Plans —Hanover, MD
- $39.64 - $61.45 an hour
- Full-time
- Nursing
- Mid-level
- Bachelor of Science in Nursing
- Health insurance
4d
Registered Nurse Utilization Review
Ascension —Baltimore, MD
- $81,120.00 - $115,939.20 a year
- Full-time
- Hybrid work
- Nursing
- RN License
- Hospital
- Disability insurance
- Health insurance
Clinical Documentation Integrity Specialist
Luminis Health —Annapolis, MD
- $93,120 - $136,344 a year
- Full-time
- RN License
- 5 years
- Computer literacy
- AD&D insurance
- Paid holidays
2d
Utilization Management Specialist II
University of Maryland Medical System —Baltimore, MD
- Full-time
- RN License
- Mid-level
- Analysis skills
Utilization Management Nurse
Luminis Health —Annapolis, MD
- $34 - $55 an hour
- Full-time
- Nursing
- RN License
- Bachelor of Science
- AD&D insurance
- Paid holidays
13d
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
Registered Nurse - Utilization Management
Spectrum Healthcare Resources —Camp Springs, MD
- 8 hour shift
- Nursing
- RN License
- Mid-level
Quick Apply
1d
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
Travel RN - Case Management/Utilization Review - Utilization Review
American Traveler —Baltimore, MD
- $1,848.19 a week
- No weekends
- Remote
- RN License
- 5 years
- Writing skills
Quick Apply
12d
Clinical Care Coordinator
University of Maryland Medical System —Largo, MD
- $47.00 - $70.54 an hour
- Full-time
- Nursing
- RN License
- Hospital
- Paid time off
Travel RN - Case Management/Utilization Review - Case Management
American Traveler —Glen Burnie, MD
- $2,691.32 a week
- 8 hour shift
- Acute care
- Nursing
- RN License
- Health insurance
Quick Apply
Utilization Management Nurse - Emergency Department
Luminis Health —Annapolis, MD
- $34 - $55 an hour
- Part-time
- Nursing
- RN License
- Hospital
- AD&D insurance
- Paid holidays
Care Coordinator
University of Maryland Medical System —Easton, MD
- Full-time
- Nursing
- RN License
- Mid-level
3d
Care Manager, RN
University of Maryland Medical System —Towson, MD
- Full-time
- RN License
- Hospital
- Inpatient
11d
RN Case Manager
Johns Hopkins Bayview Medical Center —Baltimore, MD
- Full-time
- Nursing
- Surgery
- RN License
- Health insurance
- Opportunities for advancement
5d
Nurse Navigator
GRMC Garrett Regional Medical Center —Oakland, MD
- $31.54 - $47.32 an hour
- Part-time
- Nursing
- RN License
- Bachelor of Science
- Wellness program
- Disability insurance
2d

I want to receive the latest job alert for utilization review nurse in maryland

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

utilization review nurse jobs near maryland

Clinical Documentation Improvement Specialist jobs in Annapolis, MD

Travel Nurse jobs in Baltimore, MD

Care Coordinator jobs in Easton, MD

Registered Nurse Case Manager jobs in Baltimore, MD

Senior Nurse jobs in Baltimore, MD

Travel Nurse jobs in Glen Burnie, MD

Nurse Manager jobs in Annapolis, MD

Utilization Review Nurse jobs in Baltimore, MD

Nurse Manager jobs in Towson, MD

Utility Manager jobs in Baltimore, MD

Utilization Review Nurse jobs in Clinton, MD

Clinical Nurse jobs in Baltimore, MD

Care Manager jobs in Baltimore, MD

Utilization Review Nurse jobs in Olathe, KS

School Nurse jobs in Irvine, CA

Utilization Review Nurse jobs in Wilmington, DE

Utilization Review jobs in Tampa, FL

Nurse Sign Bonus jobs in Boston, MA

Utilization Review Nurse jobs in Chattanooga, TN

Utilization Review Nurse jobs in Santa Clarita, CA

RN Team Lead Utilization Review

MedStar Health -
Clinton, MD

Quick Apply

Job Details

Full-time
$89,065 - $162,801 a year

Qualifications

RN License
Bachelor's degree
Utilization management
Bachelor's degree in nursing
Acute care experience

Full Job Description

About this Job:

Candidate must have acute care Utilization Review experience. Candidate must live in the DC/Baltimore region

General Summary of Position
Supervises the daily activities of the Utilization Review Team. Manages daily assignment ensuring all UM tasks are completed each day. Collaborates with the physician nurse case manager social worker and other members of the health care team to meet individualized patient outcomes. Assists the Director in managing the daily departmental operations with the goal of maintaining adequate staffing levels and efficient workflow. Acts as a resource and mentor to the Utilization Review staff.

Primary Duties and Responsibilities

Supervises daily activities of UM team. Monitors and arranges for adequate staffing to ensure appropriate Utilization Review coverage for units. Monitors daily workflow issues and addresses issues related to workflow in collaboration with the director as necessary.
Acts as a resource and mentor for UM Team. Oversees the orientation of new UR Coordinators by establishing the plan and monitoring progress in conjunction with other staff as necessary Serves as a resource to all staff in areas of utilization review/management. Educates members of health care team through in-services staff meetings orientation and formal educational offerings. Completes continuing education to maintain knowledge base.
Collaborates with and assists the nurse case manager and social worker to meet the patients' continuing health needs in a high-quality cost-effective manner by identifying patients in need of case management. Participates in planning rounds as needed to address and communicate issues related to acuity level of patient LOS insurance and discharge needs.
Collects quality improvement data in accordance with approved indicators. Monitors and audits staff UM reviews for completeness and compliance with standards. Recognizes potential problems and provides education to staff.
Utilizes research methods to collect tabulate and analyze data in collaboration with the case management team medical staff and hospital performance improvement initiatives. Assists CM Leadership in implementing strategies to correct or modify trends seen through data analysis and outcome monitoring.
Confers and collaborates routinely with the physician advisor and attending physicians to resolve problems regarding acuity and level of care.
Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
Identifies insurance information obtains authorization communicates with financial counseling and assigns appropriate length of stay for admission.
Implements strategies to avoid denials including potential denial notification to attending physician. Issues letter of non-coverage for Medicare or third-party payers according to policies and procedures. Communicates utilization plans to case management team. Evaluates concurrent and retrospective denials for appeal opportunities. Generates appeal letters based on knowledge of clinical severity and intensity.
Manages the department in the Director's absence. Keeps Director informed about issues related to staffing and problem areas. Keeps Director informed about issues related to quality risk patient/family issues and concerns allocation of resources and vendor/payer issues. Assists the Director in monitoring performance issues. Contributes to the performance evaluation process by giving feedback to the Director and helping create professional development plans for UR Coordinators.
Participates in multidisciplinary quality and service improvement teams.
Performs admission reviews and subsequent concurrent reviews to determine the necessity for acute care by application of accepted criteria based on age specific needs. Interacts with and assists third party payer reviewers to facilitate appropriate care and ensure payment of services. Performs concurrent and retrospective reviews telephonically as required. Completes all forms and documentation necessary to support appropriate utilization of resources.

Minimal Qualifications
Education

Bachelor's degree in Nursing required

Experience

3-4 years clinical experience in acute care setting required
2 years Case Management or Utilization Management experience preferred
1-2 years leadership experience preferred

Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure the District of Columbia or State of Maryland depending on work location required
CCM - Certified Case Manager preferred

This position has a hiring range of : USD $89,065.00 - USD $162,801.00 /Yr.

Work Location: Hybrid remote in Clinton, MD 20735

Quick Apply

Refine Your Search

utilization review nurse jobs in maryland

RN Team Lead Utilization Review

Clinical Medical Review Nurse (Remote)

Utilization Reviewer

Care Manager (Remote)

Clinical Quality Nurse (RN)

Registered Nurse Utilization Review

Clinical Documentation Integrity Specialist

Utilization Management Specialist II

Utilization Management Nurse

Medical Review Nurse III

Registered Nurse - Utilization Management

Telephonic Case Manager I

Travel RN - Case Management/Utilization Review - Utilization Review

Clinical Care Coordinator

Travel RN - Case Management/Utilization Review - Case Management

Utilization Management Nurse - Emergency Department

Care Coordinator

Care Manager, RN

RN Case Manager

Nurse Navigator

I want to receive the latest job alert for utilization review nurse in maryland

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected