Clinical Utilization Management Nurse for Outcomes

Luminis Health, Inc.; Annapolis (MD); On-site; USD 47,000 - 76,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Retirement Plan

Paid Time Off

Tuition Assistance

Employee Referral Bonus Program

Paid Holidays

Disability and Life/AD&D

Wellness Programs

Employee Assistance Program

Job summary

Luminis Health, Inc. in Annapolis, MD, is seeking a Registered Nurse to perform concurrent and retrospective chart reviews, apply utilization criteria, and support denial management to reduce delays and denied payments.

The role requires strong collaboration with care coordinators, physician advisors and other clinicians to improve patient outcomes, shorten length of stay, and participate in care management process improvement initiatives.

Qualifications

• Bachelor’s of Science in Nursing or Associate’s degree in Nursing with equivalent experience.
• BSN must be achieved within 5 years of start date in the role.
• Three years of clinical nursing in an acute care hospital setting.
• Current Maryland RN license.

Responsibilities

• Chart Review: assesses clinical, financial, and resource utilization using utilization review criteria and documents in EPIC.
• Denial Management: monitors denials and collaborates with care coordinators to resolve and prevent payment denials.
• Care Coordination: works with the care team to optimize patient outcomes and reduce length of stay.
• Process improvement: participates in care management improvement initiatives.

Skills

Chart Review

Denial Management

Care Coordination

Process improvement

Education

Bachelor’s of Science in Nursing

Associate’s degree in Nursing

Job description

Luminis Health, Inc. in Annapolis, MD, is seeking a Registered Nurse to perform concurrent and retrospective chart reviews, apply utilization criteria, and support denial management to reduce delays and denied payments.

The role requires strong collaboration with care coordinators, physician advisors and other clinicians to improve patient outcomes, shorten length of stay, and participate in care management process improvement initiatives.