Utilization Review Nurse RN
Live Well Homecare · Baltimore, MD · 1 wk ago
HealthcareFull-time
Role Overview
The Utilization Review Nurse RN is responsible for evaluating patient stays to ensure medical necessity, coordinating with physicians and payors to optimize resource utilization, minimize denials, and maximize reimbursement. This full-time position requires collaboration within the Revenue Cycle Management process, monitoring hospital resource use, and managing denials in conjunction with Case Management.
Qualifications & Skills
- BSN preferred; ADN required
- Current Maryland RN license or multistate license
- Minimum of 2 years' acute inpatient utilization review experience
Key Responsibilities
- Review patient stays for medical necessity
- Coordinate referral to physician advisors as needed
- Manage denials and collaborate with Case Management
- Monitor and optimize hospital resource utilization
Benefits
- Competitive compensation
- Health benefits
- Wellness programs
- Professional growth opportunities
- Collaborative environment