238 Results for

Utilization Management Nurse Jobs in Baltimore, MD

Jobs

New!

Randallstown, MD2 days ago

$40.12–$62.19 Per Hour

Assists nurse Care Managers in communicating with the patient denied hospital days as well as the issuance of Medicare forms including HINN, Detailed Notice of Discharge to patients/family/significant other when they are in disagreement with the discharge plan arranged by attending and Care Management personnel. 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.

New!

Baltimore, MD3 days ago

$1,461–$1,461

Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership.

Olney, MD18 days ago

$120,702–$238,222

Maintains knowledge of current trends and developments in the fields of nursing and health care through a variety of professional activities including but not limited to reading the appropriate literature attending related seminars and conferences and maintaining membership in professional nursing associations. Engages in ongoing productivity monitoring adherence to prescribed annual budget and assurance of adequate availability of personnel and other necessary resources to support the delivery of safe patient care and realization of departmental goals.

New!

Washington, DC6 days ago

$120,702–$238,222

New!

Washington, DC3 days ago

$120,702–$238,222

New!

Washington, DC6 days ago

$41.38–$94.97

CLINICAL: Identifies current and potential complex problems of a specific patient population critically analyzes trends and changes in patient status and plans appropriate interventions directly or indirectly through other nurses. CPR - Cardiac Pulmonary Resuscitation (includes BLS and NRP) for healthcare providers from either the American Heart Association (AHA) or American Red Cross within 90 Days required .

New!

Washington, DC2 days ago

$90,000–$150,000 Per Hour

As the facility leader, you will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to patients facing end stage renal disease or chronic kidney disease. We have a diverse range of employee resource groups (ERGs) to encourage employees with similar interests, goals, social and cultural backgrounds, or experiences to come together for professional and personal development, discussion, activities, and peer support.

New!

WASHINGTON, DCToday

In the past 5 years, practiced as an Advanced Practitioner for at least: 2 years in an outpatient primary care setting, OR 1 year in an outpatient primary care setting, coupled with either a 1 year primary care fellowship or 1+ year in an urgent care setting. Our seamless in-office and 24/7 virtual care services, on-site labs, and programs for preventive care, chronic care management, common illnesses and mental health concerns have been delighting people for the past fifteen years.

New!

WASHINGTON, DCToday

Woodlawn, NY7 days ago

This specialized department caters to both medical oncology patients, who receive systemic therapies like chemotherapy, immunotherapy, and targeted therapies, and surgical oncology patients, who are in various stages of their surgical journey, including pre-operative evaluation, post-operative care, and follow-up. Additional Information Smilow Ambulatory Multispecialty Department YSC (NP 1, NP4, NP8) This department is rooted in oncology nursing excellence and serves as a hub for patients undergoing cancer treatment and management for solid tumor cancers.

Washington, DC8 days ago

$41.38–$94.97

New!

WASHINGTON, DCToday

Our seamless in-office and 24/7 virtual care services, on-site labs, and programs for preventive care, chronic care management, common illnesses and mental health concerns have been delighting people for the past fifteen years. Seeing patients with a broad array of patient needs; conducting a mix of acute, chronic, and well visits (not a panel-building role).

New!

Washington, DCToday

$41.38–$94.97

Arlington, VA30+ days ago

The Nurse collaborates with rounding MAPMG Hospital Based Service Physicians, patient/family, nursing, utilization review and other members of the healthcare team to assure continuum of patient care progressions for clinical and cost-effective outcomes. The Nurse facilitates and coordinates with community providers and ambulatory case managers to assist with the appropriate level and transition of care for a safe discharge and preventing a re-admission.

New!

Washington, DC1 day ago

$59.10–$65.50 Per Hour

In the past 5 years, practiced as an Advanced Practitioner for at least: 2 years in an outpatient primary care setting seeing patients of all ages (0+), OR 2 years in an urgent care or emergency medicine setting seeing patients of all ages (0+) . The One Medical Virtual Medical Team (VMT) is a leading provider of virtual clinical care, providing world-class, convenient, evidence-based virtual medical care to One Medical patients in concert with their primary care providers.

New!

Silver Spring, MD3 days ago

$2,500–$2,650

Job Title: RN Case Manager / Patient Care Coordinator Location: Silver Spring, MD (Holy Cross Hospital – 1500 Forest Glen) Shift: Day Shift (08:30 AM – 05:00 PM) Schedule: 40 Hours/Week Duration: 560 Hours Assignment Start Date: ASAP Position Details:Department: Continuum of Care. The candidate will collaborate closely with physicians, nursing staff, patients, families, and interdisciplinary teams to facilitate smooth transitions of care and prevent hospital readmissions.

New!

Bel Air, MD3 days ago

$2,355.60–$2,355.60

Works closely with providers, social workers, and external agencies to ensure timely, efficient, and effective discharge planning and transitions. TravelNurseSource is working with Prime Staffing to find a qualified Case Manager RN in Bel Air, Maryland, 21014!

New!

Bethesda, MD4 days ago

Remote

$70,000–$80,000 Per Year

All resumes submitted by search firms to any employee at Government Solutions without a valid written agreement and task order in place will be deemed the sole property of Government Solutions and no fee will be paid in the event that person is hired by Government Solutions. We believe in helping those with work-sustained illnesses and injuries to live their best life by providing care, health management, and support through our highly skilled team of home-based Medical CaseManagers (MCM).

Washington, DC30+ days ago

$89,065–$162,801 Per Year

RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the District of Columbia; or Maryland Upon Hire required and CCM - Certified Case Manager CCM (Certified Case Manager) Upon Hire preferred. Responsible for clinical review of acute care services based on Medically Necessity criteria, the management of quality health care resources for achievement of desired outcomes, and coordination of alternative levels of care in a timely and cost-effective manner.

Washington, DC30+ days ago

$89,065–$162,801 Per Year

New!

Work At Home, DC4 days ago

$29.10–$62.32 Per Hour

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.

New!

DC3 days ago

Remote

$72,360–$143,715 Per Year

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. QUALIFICATIONS: Education Level: Bachelor''s Degree in Nursing OR in lieu of a Bachelor''s degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

New!

Randallstown, MD5 days ago

Assists nurse Care Managers in communicating with the patient denied hospital days as well as the issuance of Medicare forms including HINN, Detailed Notice of Discharge to patients/family/significant other when they are in disagreement with the discharge plan arranged by attending and Care Management personnel. 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.

Baltimore, MD24 days ago

Full-time

Role: Utilization Review Nurse Location: Baltimore MD(Remote) Type: Contract Job Description: We are seeking an experienced Utilization Review Nurse (LPN or RN) to support high-volume clinical reviews for commercial and FEP health plans. The ideal candidate will have strong utilization management and care management experience, expertise with MCG guidelines, and the ability to manage a fast-paced review environment while ensuring quality and compliance.

New!

Hanover, MD4 days ago

Remote

As a Utilization Review Registered Nurse for Johns Hopkins Health Plans, you have the opportunity to use your clinical, managed care, utilization review, and verbal/written communication skills to make a difference in our members' lives. Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States.

New!

Washington, DC1 day ago

$89,065–$162,801 Per Year

Serves as a resource to the health care team by educating the health care team through in-services staff meetings and formal educational settings in areas of utilization management. Performs patients' medical record reviews document pertinent information and communicate with third party payors in a timely fashion to ensure proper hospital reimbursement and eliminate unnecessary denials.

Baltimore, MD25 days ago

$45–$48 Per Hour

Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent and retrospective reviews for authorization, appropriateness of care determination and benefit coverage. Researches and presents educational topics related to cases, disease entities, treatment modalities to interdepartmental audiences.

Washington, DC30+ days ago

$89,065–$162,801 Per Year

Responsible for clinical review of acute care services based on Medically Necessity criteria the management of quality health care resources for achievement of desired outcomes and coordination of alternative levels of care in a timely and in the most cost-effective manner. Acts as an advocate while assisting members to coordinate and gain access to medical psychiatric psychosocial and other essential services to meet their healthcare needs.

Bethesda, MD18 days ago

Our approach is rooted in a "grow our own" philosophy, designed to help our team members build meaningful, long-term careers with us, supported by benefits that make a real difference, including: Career growth and development opportunities, with clear pathways and ongoing support Comprehensive health and wellness resources that go beyond traditional benefits A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs Tuition reimbursement to support continued learning and advancement And so much more Together, these benefits and others reflect our commitment to caring for our people, so they can build fulfilling careers with us while making a meaningful impact every day. Baptist Health is the region's largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties.

Baltimore, MD30+ days ago

Full-time

Licenses/Certifications RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon Hire Req or LPN - Licensed Practical Nurse - State Licensure CNS-Clinical Nurse Specialist Pref Additional Skills: Clinical UM expertise, regulatory compliance knowledge, experience in Guiding care platform ***Lumen and / or its clients will not provide equipment (Laptop, monitor, etc.) to the selected contractor. Education Level: Bachelor's Degree Education Details: Nursing Experience: 5 years Clinical nursing experience 2 years Care Management In Lieu of Education In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Baltimore, MD30+ days ago

$40–$48.21 Per Hour

Knowledge, Skills and Abilities (KSAs):Effective written and interpersonal communication skills to engage with members, healthcare professionals, and internal colleagues, Proficient. Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent and retrospective reviews for authorization, appropriateness of care determination and benefit coverage.

Baltimore, MD30+ days ago

Remote

Full-time

Applies clinical knowledge to make determinations for preauthorization, inpatient and continued stay reviews for Behavioral Health and Medical/Surgical requests to establish medical necessity, benefit coverage, appropriateness of quality of care, and length of stay or care plan. The Utilization Management Clinical Review nurse reviews and makes decisions about the appropriateness and level of beneficiary care being provided in an effort to provide cost effective care and ensure proper utilization of resources.

Washington, DC18 days ago

In this role, you will: Perform prospective & concurrent utilization reviews and first level determination approvals for members admitted to facilities using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare as needed. The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business.

New!

Washington, DC4 days ago

Remote

$36.80–$49.80 Per Hour

As a member of the Clinical Services team, our Care Management RN's provide clinical care management (such as case management, disease management, and/or care coordination) to best meet the member's specific healthcare needs and to promote quality and cost-effective outcomes. Collaborates with physician advisors, internal and external customers, and other departments to resolve claims, quality of care, member or provider issues, and identifies problems or needed changes, recommending resolutions and participating in quality improvement efforts.

Falls Church, VA30+ days ago

Must have one of the following: Accredited Case Manager (ACM) or Certified Case Manager (CCM), or MCG/UR or, Certified Clinical Transplant Social Worker (CCTSW) pr N/ASW-CM (ASWCM) or licensed as a Social Worker (LCSW) in Virginia or eligible to practice on the Commonwealth of Virginia as a Social Worker within 12 months of hire.\n \n\n \nPreferred Qualifications:\n\n Three (5) + years of previous Inpatient (hospital) case management experience, case management discharge planning, and two (2) years supervisory/lead experience is highly preferred. The new Magnet designation is in addition to several other prestigious recognitions which include: a five star rating from the Centers for Medicare and Medicaid Services (CMS), being named by IBM Watson Health as one the nation's highest performing hospitals, and among the top 10 Major Teaching Hospitals, an A for Patient Safety by The Leapfrog Group, the #1 hospital in the DC metro area by U.S. News & World Reports, and being nationally ranked in gynecologic care\n \nThe Manager of Case Management participates in clinical performance improvement activities.

washington, DC30+ days ago

$78,600–$107,100 Per Year

What We're Looking For:Clinical experience in complex care e.g., high-risk, medically fragile, or chronic), behavioral health, pediatrics, or transitions of careActive RN Licensure in DC required, compact licensure strongly preferred, or LICSWKnowledge of tools like InterQual or JIVAPassion for Medicaid populations and purpose-driven care4 days onsite, 1day remoteWhat You'll Find Here:An engaged, mission-first team that values clinical voicesA place where your decisions protect real peopleGrowth, mentorship, and space to leadCompetitive pay ($78,600-$107,100) plus a $5,000 sign-on bonusYou've reviewed cases. At AmeriHealth Caritas D.C., we're hiring licensed clinical professionals to join our Care Management team, supporting diverse member needs across adult, pediatric, behavioral health, and complex care populations.

Silver Spring, MD14 days ago

Role Overview: The RN Case Manager (Inpatient Care Coordinator - ICC) plays a crucial role within the interdisciplinary team, overseeing patient care from admission to transfer or discharge. Discharge Planning Leadership: Lead the team in creating complex discharge plans that balance cost-effective hospital resource use with minimized patient expenses.

Baltimore, MD30+ days ago

We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support. We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, Enterprise Transformation.

Baltimore, MD30+ days ago

ESSENTIAL FUNCTIONS: 35% Receives, researches, reviews and analyzes professional and institutional claims using critical thinking, nursing clinical judgment and corporate/medical policies for claims processing and/or adjudication, Performs high-level research on topics identified as actual or potential medical policies. The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or adjudication.

Owings Mills, MD30+ days ago

$40–$45 Per Hour

The Contingent RN supports CareFirst by analyzing high cost claimant and population health data to support utilization review, ad hoc requests, and client reports. Role Characteristics:Individual contributor who researches high cost claimants, populates slide decks, and responds to ad hoc requests.

Baltimore, MD18 days ago

The RN Case Manager applies case management strategies to assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual's healthcare needs, through communication and the use of available resources to promote quality, cost effective outcomes. The RN Case Manager responsibilities include assessing clients needs, developing individualized care plans, coordinating with physicians, social workers and ancillary staff, and advocating for clients' rights and access to resources.

New!

Randallstown, MD5 days ago

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. The Care Manger strives to promote patient wellness, improved care outcomes, efficient utilization of health services and minimize denials of payment among a patient population with complex health needs.

Baltimore, MD30+ days ago

Full-time

Role: Clinical Medical Review Nurse Location: Canton, MD – Hybrid (2–3 days/week) Job Type: Contract Job Summary: We are seeking an experienced Clinical Medical Review Nurse to perform medical record reviews, data abstraction, and claims evaluation. We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support.

Baltimore, MD30+ days ago

ESSENTIAL FUNCTIONS: 35% Receives, researches, reviews and analyzes professional and institutional claims using critical thinking, nursing clinical judgment and corporate/medical policies for claims processing and/or adjudication, Performs high-level research on topics identified as actual or potential medical policies. Job Description:PURPOSE: The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or adjudication.

Washington, DC30+ days ago

$120,702–$238,222 Per Year

Minimal Qualifications Education Bachelor's degree in Nursing from a nationally accredited program required Master's degree in Nursing or health related field from a nationally accredited program preferred Experience 5-7 years in Nursing or health related field from a Nationally accredited program required 1-2 years of management and leadership experience preferred Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure in the District of Columbia required CPR - Cardiac Pulmonary Resuscitation (includes BLS and NRP) for healthcare providers from either the American Heart Association (AHA) or American Red Cross within 90 Days required Additional unit/specialty certifications may vary by department or business unit. Specialty certification from a nationally recognized nursing organization in either his/her clinical specialty or Nursing Administration within 2 years required Knowledge Skills and Abilities Excellent problem-solving skills and ability to exercise independent judgment on highly complex situations.

Baltimore, MD30+ days ago

Manages patient care according to clinical pathways and/or multidisciplinary plan of care and/or management care contracts by directing decision making and identifying and managing barriers that impact on patient care outcomes. The RN Case Manager provides community-based care coordination and clinical support as a member of a small, collaborative team serving predominantly Spanish-speaking women age 40 and older residing in Baltimore City.

Olney, MD17 days ago

$120,702–$238,222 Per Year

New!

Washington, DC3 days ago

$120,702–$238,222 Per Year

New!

Washington, DC6 days ago

$120,702–$238,222 Per Year

Washington, DC30+ days ago

$89,065–$162,801 Per Year

Collaborates with the multidisciplinary health care team to develop and coordinate the plan of care • Communicates with patient family and/or significant other health care team external case manager community resources and facility to address appropriate issues and patient/family goals • Demonstrates the ability to develop a plan of care that addresses needs across the continuum; have an intervention for problems identified; develop long- and short-term goals with specific time frames for resolution; identify specific services to be provided in the care plan; include the family/care-giver in the plan of care; and show life planning contingencies such as power of attorney and/or advance directives. Monitors the care and services delivered to selected patient populations during the acute hospital stay promotes effective case management and utilization of resources and works to achieve optimal clinical and resource outcomes for the acute and post-hospital phases of care.

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Utilization Management Nurse Jobs in Baltimore, MD

Utilization Review Nurse RN - NE LifeBridge Health

Travel Nurse RN - Utilization Review - $1,461 per week in Baltimore, MD TravelNurseSource

Emergency Department Nurse Manager - Relocation Offered! MedStar Health

Director of Nursing (RN) Operating Room, Abdominal Transplant, Robotics and General Surgery - Relocation Offered! MedStar Health

Nursing Director (RN) Behavioral Health - Relocation Offered! MedStar Health

Clinical Nurse Medstar 1G 36/hr D/N - Relocation Offered! MedStar Health

Dialysis Clinical Manager Registered Nurse - RN Fresenius Medical Care

Primary Care Nurse Practitioner or Physician Assistant One Medical

Primary Care Nurse Practitioner or Physician Assistant - Multiple DC openings! One Medical

Medical-Surgical Registered Nurse (Med-Surg RN) Yale New Haven Health

Clinical Nurse 4H Burn/Trauma 36/hr D/N - Relocation Offered! MedStar Health

Family Medicine Nurse Practitioner (Casual Employee) One Medical

Registered Nurse RN Endoscopy Day Evening - Relocation Offered! MedStar Health

Registered Nurse (RN) – Case Manager Careers Integrated Resources Inc

Virtual Family Nurse Practitioner- DC Licensed One Medical

Travel Nurse RN - Case Manager - $2,500 to $2,650 per week in Silver Spring, MD TravelNurseSource

Travel Nurse RN - Case Manager - $2,356 per week in Bel Air, MD TravelNurseSource

Medical Case Manager EI (Remote) 2026-1463 Managed Care Advisors

RN Utilization Management MedStar Health Research Institute

RN Utilization Management MedStar Health

Utilization Management Nurse Consultant CVS Health Corp

Utilization Management Specialist - RN (Remote) Blue Cross and Blue Shield Association

Utilization Review Nurse RN Sinai Hospital of Baltimore

Utilization Review Nurse Lumen Solutions Group Inc

Utilization Review Nurse - Managed Care Johns Hopkins Hospital

RN Utilization Review (PRN) MedStar Health

Spec, Utilization Management Ampcus Incorporated

RN Utilization Mgmt MedStar Health

Utilization Review RN, Care Coordination, Bethesda West, FT, 8A-4:30P-159236 Baptist Health South Florida Inc

Spec, Utilization Management Lumen Solutions Group Inc

Health Services - Utilization Management Specialist Ampcus Incorporated

Utilization Clinical Reviewer TriWest Healthcare Alliance

Behavioral Health Utilization Mgmt Clinician, Senior Blue Cross and Blue Shield Association

Remote Care Management Nurse Cambia

Manager Case Management (Registered Nurse or Social Worker) Inova Health System

Care Management, Registered Nurse - Hybrid | Washington, D.C. AmeriHealth Caritas

RN Case Manager Inpatient Care Coordinator (Case Management) Macpower Digital Assets Edge Private Limited

Clinical Medical Review Nurse Lumen Solutions Group, Inc.

Health Services - Nurse, Clinical Medical Review Talteam

Clinical Medical Review Nurse Ampcus Incorporated

RN Case Manager Mercy Medical Center Inc

Case Manager RN Sinai Hospital of Baltimore

Clinical Medical Review Nurse Lumen Solutions Group Inc

Health Services - Nurse, Clinical Medical Review Mindlance

Nursing Director (RN) Cardiac Stroke Unit MedStar Health Research Institute

RN Bilingual Case Manager - Breast & Cervical Cancer Outpatient Program MedStar Health Research Institute

Emergency Department Nurse Manager MedStar Health Research Institute

Nursing Director (RN) Behavioral Health MedStar Health Research Institute

Director of Nursing (RN) Operating Room, Abdominal Transplant, Urology and General Surgery MedStar Health Research Institute

RN Inpatient Case Mgr - Discharge Planner MedStar Health Research Institute

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