Utilization Management RN: 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 with employer match

Paid Time Off

Tuition Assistance

Job summary

Luminis Health seeks an experienced RN to perform concurrent and retrospective chart reviews, applying utilization criteria and documenting in EPIC. This role focuses on reducing avoidable delays and supporting care coordination to resolve payer issues.

Ideal candidates have at least 3 years of acute care nursing experience, plus a Maryland RN license. BSN preferred with the required timeline, with opportunities for professional growth.

Qualifications

• Current RN license from Maryland Board of Nursing is required.
• BSN must be achieved within 5 years of start date.
• Minimum of 3 years clinical nursing in an acute care hospital.

Responsibilities

• Conducts chart reviews using utilization criteria and documents in EPIC.
• Identifies patterns in utilization and supports follow-up with care coordination for denial avoidance.
• Collaborates with Care Coordinator to reduce length of stay and avoidable delays.
• Participates in nursing unit/process improvement initiatives.

Skills

Utilization review

Care coordination

Denial management

Process improvement

Education

BSN or ADN with equivalent experience

3 years acute care nursing

Tools

EPIC

Job description

Luminis Health seeks an experienced RN to perform concurrent and retrospective chart reviews, applying utilization criteria and documenting in EPIC. This role focuses on reducing avoidable delays and supporting care coordination to resolve payer issues.

Ideal candidates have at least 3 years of acute care nursing experience, plus a Maryland RN license. BSN preferred with the required timeline, with opportunities for professional growth.