ER Utilization Review Nurse — Clinical Quality & Discharge

Boston Medical Center; Baltimore (MD); On-site; USD 68,000 - 110,000; Full time

Benefits offered by this job

Competitive salary

Free parking

Monthly bus pass subsidy

Onsite fitness center

Tuition assistance

Health, dental, vision benefits

Retirement plan

Job summary

GBMC HealthCare is seeking a RN with strong utilization review experience to support admission decisions and discharge planning. You will review electronic medical records, apply InterQual/MCG criteria, and collaborate with physicians, payers, and the care team to optimize patient outcomes and care efficiency.

The ideal candidate has 5 years in acute care with 2 years in utilization review, plus Maryland RN licensure and BSN in progress or completed.

Qualifications

• BSN or ASN with BSN in progress or enrolled in BSN with graduation within 3 years.
• MARYLAND RN license required; BSN and/or Utilization Management/Care Management certification desired.

Responsibilities

• Reviews electronic medical records during pre-admission to determine patient status and payer notifications.
• Develops initial admission reviews and provides status recommendations and discharge plans.
• Coordinates with managed care and third-party payers; ensures timely utilization compliance.
• Escalates complex cases to leadership and participates in continuous quality improvement.

Skills

InterQual criteria

Regulatory standards

Computer software

Oral/written comms

Critical thinking

Independent work

Calm under pressure

Discharge planning

Analytical skills

Interpersonal skills

Time management

Independent balance priorities

EMR review

Education

BSN or ASN with BSN in progress

Enrollment in BSN program (3 yrs)

Tools

InterQual

MCG criteria

Job description

GBMC HealthCare is seeking a RN with strong utilization review experience to support admission decisions and discharge planning. You will review electronic medical records, apply InterQual/MCG criteria, and collaborate with physicians, payers, and the care team to optimize patient outcomes and care efficiency.

The ideal candidate has 5 years in acute care with 2 years in utilization review, plus Maryland RN licensure and BSN in progress or completed.