Registered Nurse Utilization Review

• Location: Partially Remote, with onsite coverage required in Baltimore, MD.
• Facility: Ascension Saint Agnes Hospital
• Department: Utilization Management
• Schedule: Day-Shift | Full-Time

• 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.

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.

Additional Preferences:

• Specialized Expertise: Proven experience in Utilization Management, Case Management, or Clinical Documentation Improvement within a healthcare setting.
• Monday-Friday 8:00AM-4:30PM, Weekend Rotation once per month.