Registered Nurse Utilization Review

Ascension; Baltimore (MD); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Ascension Saint Agnes Hospital is seeking a Utilization Management RN in Baltimore, MD, with partial remote work and onsite coverage. The role focuses on admissions review, case management, and discharge planning to optimize patient outcomes and resource use.

The position requires Maryland RN licensure and a nursing diploma, with preferred experience in utilization management and clinical documentation improvement. Schedule is day-shift, full-time, with monthly weekend rotation.

Qualifications

• Registered Nurse credentialed from the Maryland Board of Nursing required.
• Diploma or professional licensure at time of hire.
• Preferred experience in Utilization Management or related clinical areas.

Responsibilities

• Advocate for appropriate care by reviewing admissions and service requests to ensure medical necessity.
• Guide complex patient journeys through case management to achieve high-quality outcomes.
• Resolve documentation and reimbursement hurdles to support front-line care teams.
• Coordinate discharge planning with the healthcare team for safe patient transitions.
• Maintain compliance with federal and payer regulations to protect patients and the organization.

Skills

Utilization Management

Case Management

Clinical Documentation Improvement

Education

Diploma from an accredited school/college of nursing

Job description

• Location: Partially Remote, with onsite coverage required in Baltimore, MD.
• Schedule: Day-Shift | Full-Time

Your future role at a glance

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

How you’ll make an impact in this role

• 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.

What Minimum Requirements You’ll Need

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.

Benefits that help you thrive

• Comprehensive health coverage: medical, dental, vision, prescription coverage and HSA/FSA options
• Financial security & retirement: employer-matched 403(b), planning and hardship resources, disability and life insurance
• Time to recharge: pro-rated paid time off (PTO) and holidays
• Career growth: Ascension-paid tuition (Vocare), reimbursement, ongoing professional development and online learning
• Emotional well-being: Employee Assistance Program, counseling and peer support, spiritual care and stress management resources
• Family support: parental leave, adoption assistance and family benefits
• Other benefits: optional legal and pet insurance, transportation savings and more

Life at Ascension: Where purpose meets opportunity

Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 99,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you'll find an inclusive and supportive environment where your contributions truly matter.

Equal employment opportunity employer

Ascension provides Equal Employment Opportunities (EEO) to all associates and applicants for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy, childbirth, and related medical conditions, lactation, breastfeeding, national origin, citizenship, age, disability, genetic information, veteran status, marital status, all as defined by applicable law, and any other legally protected status or characteristic in accordance with applicable federal, state and local laws. For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.