Registered Nurse Utilization Review

Ascension•Baltimore, MD

4d•$81,120 - $115,939•Hybrid

About The Position

Ascension Saint Agnes Hospital is seeking a Registered Nurse for Utilization Management. This role involves advocating for appropriate patient care by reviewing admissions and service requests to ensure patients receive the right level of medical necessity. The nurse will guide complex patient journeys through case management and consultation, support the frontline care team by resolving documentation and reimbursement hurdles, and coordinate safe discharge plans. The position also requires maintaining clinical integrity by overseeing compliance with federal and payer regulations.

Requirements

Registered Nurse credentialed from the Maryland Board of Nursing obtained prior to hire date or job transfer date required.
Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.
Proven experience in Utilization Management, Case Management, or Clinical Documentation Improvement within a healthcare setting.

Responsibilities

Advocate for appropriate care by reviewing admissions and service requests to ensure every patient receives the right level of medical necessity at the right time.
Guide complex patient journeys through expert case management and consultation, providing a roadmap for high-quality outcomes in even the most challenging clinical situations.
Support the frontline care team by resolving documentation and reimbursement hurdles, ensuring the hospital can focus its resources on direct patient care.
Coordinate seamless transitions by collaborating with the healthcare team to build safe, effective discharge plans that set patients up for success long after they leave our facility.
Maintain clinical integrity by overseeing compliance with federal and payer regulations, protecting our patients and our organization from administrative risk.