Utilization Management Nurse- FT Days

Written by jheinmiller - - Comments Off on Utilization Management Nurse- FT Days
Luminis Health
May 11, 2022
Annapolis, Maryland
Job Type


  • Sign In


Utilization Management Nurse- FT Days

Job #: DEE-80434
Category: Nursing (RN/NP/CNM)
Facility: Luminis Anne Arundel Medical Center
Location: Annapolis, MD
Posted Date: May 6, 2022






Not ready to apply, or just want to learn more about our company and the hottest job opportunities, please join our Talent Community.

Quickly join with your social network.



Position Objective:  Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of payment.

Essential Job Duties:

  1. Chart Review:

Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource utilization; enters clinical review in EPIC; maintains close communication with external reviews, care coordinators, and providers; reconciles and records days authorized in EPIC

2. Denial Management:

Monitors and identifies patterns or trends in utilization management; monitors potential and actual denials and collaborates with care coordinator for any follow up necessary; documents actions taken to avoid denial;  assists Care Coordinator in communicating with the patient denied hospital days with work toward resolution and discharge.

3. Care Coordination:

Collaborates with the Care Coordinator to achieve optimal and efficient patient outcomes while decreasing length of stay, avoidable delays and denied days; utilizes Physician Advisor and administrative personnel for unresolved issues; identifies opportunities for expedited appeals and collaborates with the care coordinator and Physician Advisor to resolve payer issues.

4.  Process improvement initiatives

Participates in nursing unit and department clinical outcome projects as well as process improvement initiatives of care management.

Educational/Experience Requirements:

  • Bachelor's of Science in Nursing.
  • Three years of clinical nursing in an acute care hospital setting.


  • Current RN license from Maryland Board of Nursing.

Working Conditions, Equipment, Physical Demands:

There is a reasonable expectation that employees in this position will be exposed to blood-borne pathogens.

Physical Demands –

Medium work. Exerting up to 50 pounds of force occasionally, and/or up to 30 pounds of force frequently, and/or up to 10 pounds of force constantly to move objects.

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

The above job description is an overview of the functions and requirements for this position.  This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.


Video thumbnail






Talent comminity icon

First step is to join our talent community for the latest news.

Create your talent profile to receive customized job alerts and the latest company information.

Current Employees

Current employees should click on the button to search jobs, login and manage job agents, check application status, and more.

Important Information about CPR (BLS) requirements for Luminis Health. (Note: this downloads a word document)


2001 Medical Parkway
Annapolis, Maryland 21401
askAAMC Nurse Advice Line:


Facebook Twitter Youtube Instagram


Learn More


level 2

Related Jobs

Comments are closed.