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Utilization review nurse [h1.location_city]

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Utilization review nurse • baltimore md

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Registered Nurse - Utilization Review

Registered Nurse - Utilization Review

AppcastBaltimore, MD, United States
[job_card.full_time]
Various health insurance options & wellness plans.Retirement benefits including employer match plans.Long-term & short-term disability. Employee assistance programs (EAP).Parental leave & adoption a...[show_more][last_updated.last_updated_30]
Clinical Medical Review Nurse

Clinical Medical Review Nurse

AmpcusBaltimore, MD
[job_card.full_time]
Technology and Business consulting services.We are in search of a highly motivated candidate to join our talented Team.The Clinical Medical Review Nurse handles day-to-day review of professional an...[show_more][last_updated.last_updated_30]
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Travel Nurse RN - Utilization Review - $1,900 per week in Baltimore, MD

Travel Nurse RN - Utilization Review - $1,900 per week in Baltimore, MD

TravelNurseSourceBaltimore, Maryland, US
[job_card.full_time]
Registered Nurse (RN) | Utilization Review.TravelNurseSource is working with GQR Healthcare to find a qualified Utilization Review RN in Baltimore, Maryland, 21287!. Adult Medicine / Surgery - start d...[show_more][last_updated.last_updated_30]
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Maine Licensed Utilization Review Nurse

Maine Licensed Utilization Review Nurse

VirtualVocationsBaltimore, Maryland, United States
[job_card.full_time]
A company is looking for a Utilization Review Nurse - Remote.Key Responsibilities Review prior authorization requests for medical necessity and collaborate with healthcare providers Manage medic...[show_more][last_updated.last_updated_1_day]
UTILIZATION REVIEW NURSE - PRN

UTILIZATION REVIEW NURSE - PRN

Facility SINAI HOSPITALBaltimore, MD, US
[job_card.full_time]
Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information.Provides intervention and coordination to decrease avoidable delays and denial of pay...[show_more][last_updated.last_updated_30]
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Clinical Medical Review Nurse

Clinical Medical Review Nurse

Lumen Solutions Group, Inc.Baltimore, MD, United States
[job_card.full_time]
Canton, MD (Hybrid - 2-3 days onsite per week).Licensed Practical Nurses (LPN).Clinical Medical Review Nurses.This is a hybrid contract position requiring both remote work and regular onsite presen...[show_more][last_updated.last_updated_30]
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Utilization Review Registered Nurse, Monday-Friday 9 : 00AM-5 : 30PM, 1 holiday / year, on-call every[...]

Utilization Review Registered Nurse, Monday-Friday 9 : 00AM-5 : 30PM, 1 holiday / year, on-call every[...]

Greater Baltimore Medical Center (GBMC)Baltimore, MD, United States
[job_card.full_time]
Under general supervision, provides consultative support to the admitting teams concerning patient status determinations and utilization of hospital resources facilitating quality, cost-effective p...[show_more][last_updated.last_updated_variable_days]
Utilization and Clinical Review - Medical Director - Orthopedic Surgery - Remote

Utilization and Clinical Review - Medical Director - Orthopedic Surgery - Remote

UnitedHealth GroupBaltimore, MD, US
[filters.remote]
[job_card.full_time]
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives.The work you do with our team will directly improve health outcomes by connect...[show_more][last_updated.last_updated_30]
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  • [new]
Utilization Management Specialist

Utilization Management Specialist

Johns Hopkins MedicineBaltimore, MD, United States
[job_card.full_time]
Johns Hopkins Bayview Medical Center, Baltimore, MD 21224 .Our staff provides compassionate healthcare focused on the uniqueness and dignity of each person we serve. Click or copy and paste this ...[show_more][last_updated.last_updated_variable_hours]
UTILIZATION REVIEW / CASE MANAGEMENT RN - Part Time, Weekends

UTILIZATION REVIEW / CASE MANAGEMENT RN - Part Time, Weekends

Facility GRACE MEDICAL CENTERBaltimore, MD, US
[job_card.part_time]
Every other weekend, 9a-9 : 30p; 16 hours bi-weekly.Position is on-site and requires ability commute to Grace Medical Center for scheduled shifts. Conducts concurrent and retrospective chart review fo...[show_more][last_updated.last_updated_30]
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Health Services - Nurse, Clinical Medical Review

Health Services - Nurse, Clinical Medical Review

TalTeamBaltimore, MD, United States
[job_card.full_time]
The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benef...[show_more][last_updated.last_updated_variable_days]
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Utilization Management CoordinatorNE

Utilization Management CoordinatorNE

University of Maryland Medical SystemGlen Burnie, MD, United States
[job_card.full_time]
Experience the highest level of appreciation at UM Baltimore Washington Medical Center - named Top Workplace in the Baltimore area by The Baltimore Sun two years in a row (2019 & 2020); Top Workpla...[show_more][last_updated.last_updated_30]
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Health Services - Nurse, Clinical Medical Review

Health Services - Nurse, Clinical Medical Review

Aequor TechnologiesBaltimore, MD, United States
[job_card.full_time]
The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benef...[show_more][last_updated.last_updated_variable_days]
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As-Needed Utilization Review Registered Nurse, Day Shift

As-Needed Utilization Review Registered Nurse, Day Shift

Greater Baltimore Medical Center HealthcareTowson, MD, United States
[job_card.full_time]
Under general supervision, utilize clinical knowledge and critical thinking skills to provide oversight of appropriate admission status and utilization of hospital resources facilitating quality, c...[show_more][last_updated.last_updated_30]
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Clinical Medical Review Nurse

Clinical Medical Review Nurse

Cynet SystemsBaltimore, MD, United States
[job_card.full_time]
The Clinical Medical Review Nurse is responsible for reviewing, researching, and analyzing professional and institutional claims using nursing clinical judgment, critical thinking, and established ...[show_more][last_updated.last_updated_30]
Clinical Medical Review Nurse

Clinical Medical Review Nurse

EliteTechnicalHybrid, Canton, MD
[job_card.full_time]
Seeking a Medical Review Nurse for a long term contract position with our customer, a major Healthcare Insurance organization in the Maryland area. The Medical Review Nurse handles day to day review...[show_more][last_updated.last_updated_30]
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Utilization Review Nurse RN - PRN

Utilization Review Nurse RN - PRN

LifeBridge HealthBaltimore, MD, United States
[job_card.full_time]
Utilization Review Nurse RN - PRN Baltimore, MD SINAI HOSPITAL UTILIZATION REVIEW PRN - Day shift - 8 : 00am-4 : 30pm RN OTHER 92270 $50. Posted : December 16, 2025 Apply Now Save Job Saved Summary Who W...[show_more][last_updated.last_updated_30]
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Utilization Review Tech

Utilization Review Tech

MedStar HealthBaltimore, MD, United States
[job_card.full_time]
MedStar Health is looking for a Utilization Review Technician to join our team at MedStar Harbor Hospital.The Utilization Review Technician will collaborate with and assist the multidisciplinary te...[show_more][last_updated.last_updated_variable_days]
Travel Case Management (Utilization Review) RN (Registered Nurse) in Baltimore, MD - 1039021

Travel Case Management (Utilization Review) RN (Registered Nurse) in Baltimore, MD - 1039021

Medical SolutionsBaltimore, MD, US
[job_card.full_time]
[filters_job_card.quick_apply]
A facility in Baltimore, MD is seeking its next amazing RN (Registered Nurse) to work in Case Management (Utilization Review). Nurses and allied healthcare professionals are in high demand nationwid...[show_more][last_updated.last_updated_variable_days]
Registered Nurse - Utilization Review

Registered Nurse - Utilization Review

AppcastBaltimore, MD, United States
[job_card.30_days_ago]
[job_preview.job_type]
  • [job_card.full_time]
[job_card.job_description]

Details

  • Department : Utilization Management
  • Schedule : Full-time, Day shift
  • Facility : St. Agnes Hospital
  • Location : Baltimore, MD
  • Salary : $74,547.20 - $111,820.80 per year

Benefits

Paid time off (PTO)

Various health insurance options & wellness plans

Retirement benefits including employer match plans

Long-term & short-term disability

Employee assistance programs (EAP)

Parental leave & adoption assistance

Tuition reimbursement

Ways to give back to your community

Benefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, performance and salary range at the time of the offer.

Responsibilities

Provide health care services regarding admissions, case management, discharge planning and utilization review.

Responsibilities :

  • Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and / or compliance with reimbursement policy criteria. Provide case management and / or consultation for complex cases.
  • Assist departmental staff with issues related to coding, medical records / documentation, precertification, reimbursement and claim denials / appeals.
  • Assess and coordinate discharge planning needs with healthcare team members.
  • May prepare statistical analysis and utilization review reports as necessary.
  • Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.
  • Requirements

    Licensure / Certification / Registration :

  • Registered Nurse credentialed from the Maryland Board of Nursing obtained prior to hire date or job transfer date required.
  • Education :

  • Diploma from an accredited school / college of nursing OR Required professional licensure at time of hire.
  • Why Join Our Team

    Ascension Saint Agnes in Baltimore, Maryland operates a full-service, 254-bed teaching hospital, the Ascension Saint Agnes Medical Group, Ascension Saint Agnes Imaging Center and Ascension Saint Agnes Foundation. As an associate, you will be a part of a team that is committed to providing a place of respect and inclusion for all associates, as well as a rich learning environment with countless opportunities for career growth and professional development.

    Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.

    Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.

    Equal Employment Opportunity Employer

    Ascension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.

    For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.

    As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension.

    Pay Non-Discrimination Notice

    Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.

    This Ministry does not participate in E-Verify and therefore cannot employ STEM OPT candidates.

    Responsibilities

    Provide health care services regarding admissions, case management, discharge planning and utilization review.

    Responsibilities :

  • Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and / or compliance with reimbursement policy criteria. Provide case management and / or consultation for complex cases.
  • Assist departmental staff with issues related to coding, medical records / documentation, precertification, reimbursement and claim denials / appeals.
  • Assess and coordinate discharge planning needs with healthcare team members.
  • May prepare statistical analysis and utilization review reports as necessary.
  • Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.
  • Qualifications

    Licensure / Certification / Registration :

  • Registered Nurse credentialed from the Maryland Board of Nursing obtained prior to hire date or job transfer date required.
  • Education :

  • Diploma from an accredited school / college of nursing OR Required professional licensure at time of hire.