Utilization Review Nurse: InterQual Expert for Care

Greater Baltimore Medical Center (GBMC); Baltimore (MD); On-site; USD 68,000 - 110,000; Full time

Job summary

Greater Baltimore Medical Center (GBMC) seeks a Nurse Utilization Review professional to determine patient status for hospital services using InterQual criteria. You will perform concurrent reviews, assist with discharge planning, and collaborate with physicians, payers, and care teams to ensure appropriate utilization and high-quality outcomes.

The role requires a BSN (or ASN with BSN in progress) and Maryland RN licensure, with 5 years in acute care and 2+ years in utilization review or case

Qualifications

• BSN required or ASN with BSN in progress (3-year graduation window).
• Current Maryland RN license and BSN degree.
• Utilization Management/Care Management certification desired.

Responsibilities

• Review electronic medical records to determine patient status and payer notifications.
• Assess admission and continued-stay criteria for defined patient groups.
• Draft initial admission reviews and provide status recommendations to admitting providers.
• Coordinate with managed care and third-party payers for authorizations.
• Support discharge planning and identify appropriate post-acute care.
• Stay updated on regulatory changes affecting care and reimbursement.

Skills

InterQual knowledge

Utilization review

Discharge planning

Critical thinking

Oral and written communication

Independent problem solving

Time management

EMR review

Regulatory knowledge

Interdisciplinary collaboration

Influencing skills

Education

BSN

ASN with BSN in progress

Tools

InterQual/MGC criteria software

Job description

Greater Baltimore Medical Center (GBMC) seeks a Nurse Utilization Review professional to determine patient status for hospital services using InterQual criteria. You will perform concurrent reviews, assist with discharge planning, and collaborate with physicians, payers, and care teams to ensure appropriate utilization and high-quality outcomes.

The role requires a BSN (or ASN with BSN in progress) and Maryland RN licensure, with 5 years in acute care and 2+ years in utilization review or case