Utilization Review RN - Case Management & Discharge Planning

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

Job summary

GBMC HealthCare is seeking an experienced nurse-utilization reviewer to determine patient status and optimize payer notifications during pre-admission.

The role focuses on concurrent reviews, discharge planning, and adherence to InterQual/MCG guidelines, with strong communication and analytical requirements. You will collaborate with physicians, payers, and care teams to ensure quality outcomes.

Qualifications

• BSN or ASN with BSN in progress, expected graduation within 3 years.
• Maryland RN license required; BSN; Utilization Management/Care Management certification desired.
• Five years of acute care and/or related experience; two years in utilization review/case management with discharge planning.
• Advanced knowledge of utilization review guidelines and payer criteria.

Responsibilities

• Review EMRs during pre-admission to determine patient status and payer notifications.
• Assess admission and continued stay criteria for defined patient groups.
• Develop initial admission reviews and provide status and discharge plans.
• Coordinate with managed care and third-party payers; ensure timely authorizations.
• Educate clinicians on admission decisions and documentation standards.
• Stay current with regulatory changes affecting care delivery.

Skills

InterQual knowledge

MCG criteria

Healthcare regulatory standards

Advanced computer skills

Oral and written communication

Critical thinking

Independent problem solving

Discharge planning

EMR review proficiency

Interpersonal communication

Education

BSN

ASN pursuing BSN (in progress)

Tools

InterQual

MCG criteria

EMR systems

Job description

GBMC HealthCare is seeking an experienced nurse-utilization reviewer to determine patient status and optimize payer notifications during pre-admission.

The role focuses on concurrent reviews, discharge planning, and adherence to InterQual/MCG guidelines, with strong communication and analytical requirements. You will collaborate with physicians, payers, and care teams to ensure quality outcomes.