Utilization Management Nurse: Denials & Care Coordination

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

Benefits offered by this job

Medical, Dental, Vision Insurance

Retirement Plan

Paid Time Off

Tuition Assistance Benefits

Employee Referral Bonus Program

Paid Holidays

Job summary

Luminis Health is seeking a registered nurse (RN) to conduct concurrent and retrospective chart reviews and coordinate care to reduce delays and denial of payment. The role involves reviewing records in EPIC, communicating with care coordinators and providers, and supporting denial avoidance and discharge planning. Requires a BSN or ADN with experience; BSN to be obtained within 5 years.

Three years of clinical nursing in an acute care setting are required. Maryland RN license is mandatory.

Qualifications

• RN licensed or eligible to practice in Maryland.
• 3 years of clinical nursing in an acute care hospital.

Responsibilities

• Review medical records using utilization criteria to assess clinical, financial, and resource use.
• Monitor denial patterns and assist with follow-up to prevent denials and expedite resolutions.
• Coordinate with Care Coordinator to improve patient outcomes and reduce length of stay.
• Support process improvement initiatives within care management.

Skills

Clinical nursing

Education

Bachelor’s of Science in Nursing

Associate’s degree in Nursing

Job description

Luminis Health is seeking a registered nurse (RN) to conduct concurrent and retrospective chart reviews and coordinate care to reduce delays and denial of payment. The role involves reviewing records in EPIC, communicating with care coordinators and providers, and supporting denial avoidance and discharge planning. Requires a BSN or ADN with experience; BSN to be obtained within 5 years.

Three years of clinical nursing in an acute care setting are required. Maryland RN license is mandatory.