Utilization Review Nurse, PRN

Job Description

Job Description

Company Description

University of Maryland Upper Chesapeake Health (UM UCH) offers the residents of northeastern Maryland an unparalleled combination of clinical expertise, leading-edge technology, and an exceptional patient experience.

A community-based, integrated, non-profit health system, our vision is to become the preferred, integrated health system creating the healthiest community in Maryland. We are dedicated to maintaining and improving the health of the people in our community through an integrated health delivery system that provides high quality care to all. Our commitment to service excellence is evident through a broad range of health care services, technologies and facilities. We work collaboratively with our community and other health organizations to serve as a resource for health promotion and education.

Today, UM UCH is the leading health care system and second largest private employer in Harford County. Our 3,500 team members and over 650 medical staff physicians serve residents of Harford County, eastern Baltimore County, and western Cecil County.

Job Description

Responsible for performing utilization management.  Proactively review, identify and document potentially avoidable utilization and patient quality / efficiency concerns.  Work collaboratively with internal team as well as external entities to reduce potentially avoidable utilization and denials.  Evaluates utilization documentation and recommends processes related to optimal reimbursement and compliance.  Perform compliance tasks related to utilization.

Qualifications

Education & Training : Current Maryland RN license required.  Bachelors of Science degree in Nursing preferred.

Work Orientation & Experience :

Minimum of 3 years’ acute care experience required. Experience in utilization management, case management and discharge planning preferred.  Basic computer skills required.

Skills & Abilities :

Demonstrate skill in a) performing complete clinical assessments; b) effective critical thinking skills both written and oral; and c) age appropriate interpersonal interactions (patients may range from newborn to geriatric adult.)

Ability to a) communicate and collaborate effectively with both internal and external customers (colleagues, Medical Staff, liaisons, and patient / family); b) assess, adapt, and calmly respond to changing and / or crisis environment; c) make independent decisions consistent with current policies, procedures, and ethical standards; d) prioritize work assignments and manage time effectively to complete duties; and e) assist in data analysis.

Additional Information

Skills & Abilities :

• Demonstrates proficiency in clinical case management, conducting comprehensive assessments, and utilizing effective critical thinking skills both in writing and verbally.
• Exhibits age-appropriate interpersonal interactions with patients ranging from newborns to geriatric adults.

Abilities :

All your information will be kept confidential according to EEO guidelines.

Compensation : Pay Range :  43.26

Other Compensation (if applicable) : n / a

Review the 2025-2026 UMMS Benefits Guide