Utilization Review Nurse RN - Grace Medical Center

Utilization Review Nurse RN - Grace Medical Center

Baltimore, MD

GRACE MEDICAL CENTER

Full-time - Day shift - 7 : 00am-7 : 30pm

RN Other

91224

$38.20-$59.21 Experience based

Posted : July 30, 2025

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Summary

JOB SUMMARY :

Conducts initial, concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides

intervention and coordination to decrease avoidable delays and denial of payment. Interfaces with 3rd party payers by providing

pertinent, relevant clinical information.

Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource consumption. Enters

clinical reviews into the software program. Maintains close communication with external reviewers / internal financial

counselors / patient access personnel and performs certification activities as required by payor.

Coordinates with the Care Manager to achieve optimal and efficient patient outcomes, while decreasing length of stay and avoid

delays and denied days. Utilizes Physician Advisor and administrative personnel for unresolved issues. Identifies opportunities for expedited appeals and collaborates with the Care Manager and Physician Advisor to resolve payer issues. Other tasks as assigned.

REQUIREMENTS :

Additional Information

Who We Are :

LifeBridge Health is a dynamic, purpose-driven health system redefining care delivery across the mid-Atlantic and beyond, anchored by our mission to “improve the health of people in the communities we serve.” Join us to advance health access, elevate patient experiences, and contribute to a system that values bold ideas and community-centered care.

What We Offer :

Impact : Join a team that values innovation and outcomes, delivering life-saving care to our youngest and most vulnerable patients.

Growth : Opportunities for professional development, including tuition reimbursement and developing foundational skills for neonatal critical care leadership and advanced certification.

Support : A culture of collaboration with resources like unit-based practice councils and advanced clinical education support — improving both workflow efficiency and patient outcomes and allowing you to work at the top of your license.

Benefits : Competitive compensation (additional compensation such as overtime, shift differentials, premium pay, and bonuses may apply depending on job), comprehensive health plans, free parking, and wellness programs.

Why LifeBridge Health?

With over 14,000 employees, 130 care locations, and two million annual patient encounters, we combine strategic growth, innovation, and deep community commitment to deliver exceptional care anchored by five leading centers in the Baltimore region : Sinai Hospital of Baltimore, Grace Medical Center, Northwest Hospital, Carroll Hospital, and Levindale Hebrew Geriatric Center and Hospital.

Our organization thrives on a culture of CARE BRAVELY—where compassion, courage, and urgency drive every decision, empowering teams to shape the future of healthcare.

LifeBridge Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex or sexual orientation and gender identity / expression. LifeBridge Health does not exclude people or treat them differently because of race, color, national origin, age, disability, sex or sexual orientation and gender identity / expression.

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