Utilization Review Nurse RN

Role Overview The Utilization Review Nurse RN is responsible for reviewing patient stays for medical necessity, coordinating with physicians and payors to ensure efficient resource utilization, minimize denials, and optimize reimbursement. The role involves monitoring hospital resource use, managing denials in collaboration with Case Management, and supporting revenue cycle processes. Key Responsibilities Assessing medical necessity of patient admissions and referralsManaging denial processes and coordinating with relevant teamsMonitoring hospital resource utilization to ensure efficiency Qualifications & Skills ADN required; BSN preferredCurrent Maryland RN license or multi-state licenseMinimum of 2 years' experience in acute inpatient utilization review Additional Information The role offers opportunities for professional growth, collaboration, and benefits including competitive compensation, health plans, and wellness programs. The position emphasizes innovation, community-centered care, and working at the top of one's license in a supportive environment committed to improving patient outcomes.