Utilization Management RN (Remote) | Baltimore, MD |

Morgan Stephens•Baltimore, MD

1d•Remote

About The Position

Morgan Stephens represents the nation’s top healthcare systems, offering highly competitive compensation and benefits to top candidates. We are led by experienced healthcare industry professionals and specialize in contract, contract-to-hire, and direct placement services nationwide. We have successfully placed thousands of healthcare professionals into organizations seeking high-quality talent and continue to partner with leading health systems and managed care organizations. The Utilization Management RN plays a critical role in ensuring healthcare services are delivered with quality, cost efficiency, and full regulatory compliance. Through ongoing review and audit of clinical documentation, this role helps prevent unnecessary procedures, ineffective treatment, and extended hospital stays. This position is ideal for an RN with strong clinical judgment, prior authorization experience, and a background in managed care, hospital case management, or utilization review.

Requirements

Active, unrestricted Registered Nurse (RN) license in Maryland or compact state (required)
Minimum of 2+ years of experience in Utilization Management or Case Management
Strong knowledge of MCG or InterQual guidelines
Experience with prior authorizations, concurrent review, and medical necessity determinations
Proficiency in EMR systems and Microsoft Office (Excel, Word, Outlook)
Strong critical thinking, organizational, and communication skills
Ability to work independently in a fully remote environment

Nice To Haves

Bachelor’s degree in Nursing (BSN preferred)
Managed care or health plan experience (Medicaid or Medicare populations preferred)
Experience with Maryland Medicaid or long-term services and supports (LTSS)
Utilization Management (UM) or Case Management certification (CCM, ACM) preferred

Responsibilities

Perform concurrent review of patient clinical information for medical necessity and efficiency
Conduct ongoing review of precertification and prior authorization requests
Ensure services align with established clinical guidelines (MCG or InterQual)
Monitor the activities of clinical and non-clinical staff related to utilization processes
Coordinate discharge planning needs with the interdisciplinary healthcare team
Advocate for quality care and improved patient outcomes
Identify opportunities to reduce unnecessary hospital stays and prevent complications
Maintain accurate and timely documentation of all patient-related interactions
Prepare reports on patient management, utilization trends, and cost savings
Provide daily updates to the Manager of Utilization Management
Work effectively in a fast-paced, high-volume environment with minimal supervision