Utilization Management RN: Denials & Care Coordination

Socket.dev; Annapolis (MD); On-site; USD 47,000 - 76,000; Full time

Benefits offered by this job

Medical Insurance

Retirement Plan

Paid Time Off

Job summary

Luminis Health in Annapolis, MD is seeking a Registered Nurse to conduct concurrent and retrospective chart reviews to support clinical, financial, and resource utilization decisions. The role focuses on reducing delays, denials, and length of stay through effective coordination with the care team.

Responsibilities include utilization review, denial management, and participation in process improvement initiatives to optimize patient outcomes and hospital efficiency.

Qualifications

• Bachelor’s of Science in Nursing or Associate’s degree in Nursing with equivalent experience.
• BSN must be achieved within 5 years of start date in the role.
• Three years of clinical nursing in an acute care hospital setting.

Responsibilities

• Chart Review: Review medical records to assess clinical, financial, and resource utilization; enter in EPIC and communicate with external reviews and providers.
• Denial Management: Monitor denials and work with care coordinator to resolve payer issues and avoid denial.
• Care Coordination: Collaborate to improve patient outcomes, reduce length of stay and delays, and expedite appeals.
• Process improvement initiatives: Participate in nursing unit and department clinical outcome projects.

Skills

Clinical nursing

Utilization review

Care coordination

Communication

Education

BSN or ADN

Tools

EPIC

Job description

Luminis Health in Annapolis, MD is seeking a Registered Nurse to conduct concurrent and retrospective chart reviews to support clinical, financial, and resource utilization decisions. The role focuses on reducing delays, denials, and length of stay through effective coordination with the care team.

Responsibilities include utilization review, denial management, and participation in process improvement initiatives to optimize patient outcomes and hospital efficiency.