Utilization Mgmt Registered Nurse

Make It Happen At Hopkins

Evaluates the medical necessity and appropriateness of healthcare services to ensure cost-effective and quality patient care. Conducts clinical reviews coordinates with healthcare providers and communicates with payors to secure required authorizations. Advocates for patients and optimizes care coordination. Reviews complex inpatient outpatient and post-acute cases to ensure compliance with medical policy regulatory requirements and payor guidelines. Communicates effectively with payors and healthcare providers to resolve utilization issues support authorization decisions and reduce avoidable denials.

Essential Functions:

Reviews patient medical records to determine the appropriateness of admissions and continued stays.
Coordinates patient cases and ensures appropriate utilization of resources.
Communicates with internal and external stakeholders for service authorizations and appeals.
Monitors patient progress and intervenes in cases as required.
Participates in interdisciplinary team meetings for care coordination.
Documents utilization management activities and outcomes accurately.

Position Details:

Location: Howard County Medical Center

Hours: Day Shift ( 24 hours per week)

Qualifications:
Bachelor of Science in Nursing (BSN) in nursing (Required)
RN - Registered Nurse License (Required)
CPR - Basic CPR (Required)
5 years of experience in clinical nursing (Required)

Salary Range: Minimum 43.61/hour - Maximum 67.59/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount salary discussions will occur during candidate screening calls before any subsequent compensation discussion is held between the candidate and any hiring authority.

The Hospital reserves the right to modify employee schedules as needed.

We are committed to creating a welcoming and inclusive environment where we embrace and celebrate our differences where all employees feel valued contribute to our mission of serving the community and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity and expression age national origin mental or physical disability genetic information veteran status or any other status protected by federal state or local law.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.

Required Experience:

IC