Top 51 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
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RN Case Manager
Mercy Medical Center —Baltimore, MD
- $36.92 - $66.46 an hour
- Full-time
- Nursing
- RN License
- Hospital
- 403(b) matching
- Paid holidays
RN Inpatient Case Manager Part-Time ( Emergency Dept )
MedStar Health —Olney, MD
- $89,065 - $162,801 a year
- Part-time
- Acute care
- Nursing
- Microsoft Excel
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)
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4d
Utilization Management Registered Nurse
Humana —Maryland
- $71,100 - $97,800 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
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
Medical Review Nurse III
RELI GROUP INC —Baltimore, MD
- $80,000 - $95,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
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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
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12d
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
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
Travel RN - Case Management/Utilization Review - Case Management
American Traveler —Silver Spring, MD
- $2,917 a week
- 8 hour shift
- Acute care
- Nursing
- RN License
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Utilization Reviewer
University of Maryland Medical System —Largo, MD
- $40.61 - $60.96 an hour
- Full-time
- Nursing
- RN License
- Hospital
1d
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
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
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Nurse CARE Manager, Wellness Center & Case Management
Marriott International, Inc —Bethesda, MD
- $84,000 - $147,500 a year
- Full-time
- CPR Certification
- Nursing
- Medication administration
- Commuter assistance
- Paid parental leave
8d
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
Registered Nurse - Utilization Management
Spectrum Healthcare Resources —Camp Springs, MD
- 8 hour shift
- Nursing
- RN License
- Mid-level
Quick Apply
2d
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
Utilization Management Nurse - Emergency Department
Luminis Health —Annapolis, MD
- $34 - $55 an hour
- Part-time
- Nursing
- RN License
- Hospital
- AD&D insurance
- Paid holidays
Experienced Skilled Home Care RN Clinical Managers
TidalHealth Home Care Maryland —Salisbury, MD
- $85,000 - $100,000 a year
- Full-time
- Background check
- CPR Certification
- Nursing
- Travel reimbursement
- Paid training
Quick Apply

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utilization review nurse jobs near maryland

RN Team Lead Utilization Review

MedStar Health -
Clinton, MD

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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

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Refine Your Search

utilization review nurse jobs in maryland

RN Team Lead Utilization Review

RN Case Manager

RN Inpatient Case Manager Part-Time ( Emergency Dept )

Clinical Medical Review Nurse (Remote)

Utilization Management Registered Nurse

Registered Nurse Utilization Review

Medical Review Nurse III

Travel RN - Case Management/Utilization Review - Utilization Review

Care Manager (Remote)

Utilization Management Nurse

Travel RN - Case Management/Utilization Review - Case Management

Utilization Reviewer

Clinical Documentation Integrity Specialist

Telephonic Case Manager I

Nurse CARE Manager, Wellness Center & Case Management

Clinical Care Coordinator

Registered Nurse - Utilization Management

Clinical Quality Nurse (RN)

Utilization Management Nurse - Emergency Department

Experienced Skilled Home Care RN Clinical Managers

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