Utilization Review Nurse: Discharge & Care Coordination

GBMC HealthCare; Towson (MD); On-site; USD 68,000 - 110,000; Full time

Job summary

GBMC HealthCare in Towson, MD seeks an experienced Utilization Review/Case Management RN to lead admission reviews and discharge planning. The role demands five years in acute care and two years in UR/CM, with a Maryland RN license and BSN/ASN with BSN in progress.

Knowledge of InterQual, payer coordination, and regulatory standards is essential. The successful candidate will excel in critical thinking, communication, and independent problem solving, while navigating complex cases and ensuring

Qualifications

• 5+ years of diversified experience in acute care or related settings.
• 2+ years of Utilization Review and Case Management with discharge planning.
• Current Maryland RN license.
• BSN or ASN with BSN enrollment and expected graduation within 3 years.

Responsibilities

• Reviews EMR during pre-admission to determine status and payer notifications.
• Assesses admission and continued stay criteria for defined patient groups.
• Develops initial admission reviews and provides discharge plans per guidelines.
• Coordinates with managed care and payers; discusses issues with payers.
• Ensures timely utilization compliance; considers financial resources for care.
• Partners with physicians and teams; educates staff on admission decisions.
• Keeps knowledge of regulatory changes affecting care and reimbursement.
• Identifies system obstacles; proposes solutions with team input.
• Assists with discharge planning and post-acute care placement.
• Demonstrates mastery of InterQual guidelines; proficient in review systems.
• Promotes evidence-based protocols to improve quality and cost-effectiveness.
• Escalates complex cases to leadership with possible solutions.
• Performs concurrent reviews and other duties as assigned.

Skills

InterQual MCg criteria

Regulatory standards

Computer software

Oral and written communication

Critical thinking

Independent with complex problems

Calm under pressure

Discharge needs assessment

Analytical skills

Interpersonal communication

Organization and time mgmt

Independent priority management

EMR review proficiency

Education

BSN

ASN

Job description

GBMC HealthCare in Towson, MD seeks an experienced Utilization Review/Case Management RN to lead admission reviews and discharge planning. The role demands five years in acute care and two years in UR/CM, with a Maryland RN license and BSN/ASN with BSN in progress.

Knowledge of InterQual, payer coordination, and regulatory standards is essential. The successful candidate will excel in critical thinking, communication, and independent problem solving, while navigating complex cases and ensuring