RN Clinical Denials Lead & Reimbursement Expert

University of Maryland Medical System Corporation; Linthicum (MD); On-site; USD 110,000 - 140,000; Full time

Job summary

University of Maryland Medical System Corporation is seeking an experienced nurse to support the Denials Prevention Team. The role focuses on clinical denial management, utilization review, and regulatory compliance to optimize reimbursement outcomes across the health system.

Lead clinical resource duties include mentorship, education, and quality oversight while collaborating with physicians, CDI, coding, and revenue cycle leaders to identify denial trends and drive process improvements.

Qualifications

• Bachelor of Science in Nursing and active Maryland RN license.
• Certification in Case Management, Utilization Management, Revenue Cycle, CDI or related specialty.
• Five years of professional nursing experience in acute care.
• Three years in clinical denials management, utilization review, or revenue cycle operations.

Responsibilities

• Assist the Director in supporting daily operations and oversight of the Denials Prevention Team.
• Serve as lead clinical resource and SME for reimbursement denials and utilization management.
• Provide guidance, mentorship, education, and quality oversight to staff.
• Collaborate with physicians, revenue cycle leaders, case management, coding, CDI, and patient financial services to identify denial trends and optimize reimbursement.
• Develop reports, educational materials, and presentations on denial trends and payer activity.
• Participate in recruitment, onboarding, and staff development; provide feedback on performance.
• Perform other related duties as assigned.

Skills

Clinical denial management

Regulatory compliance

Denials analytics

Payer audits

Education

BSN

RN license Maryland

Certification in Case Management/Utilization Management/CDI

Job description

University of Maryland Medical System Corporation is seeking an experienced nurse to support the Denials Prevention Team. The role focuses on clinical denial management, utilization review, and regulatory compliance to optimize reimbursement outcomes across the health system.

Lead clinical resource duties include mentorship, education, and quality oversight while collaborating with physicians, CDI, coding, and revenue cycle leaders to identify denial trends and drive process improvements.