Utilization Review Nurse RN - NE

Other Jobs To Apply

No other job posts for this day.

Job ID: 963
Facility: Northwest Hospital Center
Department/Specialty: NW Care Management
City: Randallstown
Employment Type: Part Time
Shift: Weekends 8:00a - 4:30p
Date Posted: September 30, 2026


Work Schedule: This is an EVERY Saturday and Sunday role

Summary:

The Utilization Review Nurse RN 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.

Responsibilities Include:

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.

Monitors and identifies patterns or trends in utilization management. Monitors potential and actual denials and coordinates with nurse Care Manager and/or Social Worker for any follow up necessary. Documents in software program the actions taken to coordinate care and avoid denials. 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.

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.

Sends appropriate referrals/escalations to the physician advisors to review cases not met with criteria

REQUIREMENTS:

Registered Nurse License - Current Maryland license or eligibility to obtain Maryland license

Associate's Degree in Nursing required; BSN or higher preferred

Minimum of 3 years of related experience



Pay Range: $40.12 to $62.19 Based On Experience

Benefits:

Medical, dental, and vision coverage starting the first of the month after hire, plus wellness programs and mental health support

403(b) retirement plan with employer match, pension, and life and disability insurance

Tuition reimbursement toward advanced degrees and specialty certifications

Generous paid time off, fitness discounts, and free on-site parking

About Northwest Hospital

Northwest Hospital is a full-service community hospital in Baltimore County serving Randallstown, Pikesville, Owings Mills, and beyond. As part of LifeBridge Health - one of the region's most comprehensive healthcare systems - Northwest delivers compassionate, high-quality care close to home, with a mission to improve the health of the communities we serve, and to take care of the people who take care of patients.

About LifeBridge Health

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.

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 Maryland.

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.

Back to blog

Other Jobs To Apply

Part-Time Job in Mesquite – Fulfillment Center Shipping

OnlyFans Support Associate - Live Chat (Remote / No Experience)

(Part-Time Online Remote) Walmart Customer Service Representative – WFH

Data Entry Specialist – Remote (Part time/Full time) – Las Vegas, NV

Food Warehouse Packer 2nd and 3rd shift

Urgent Part-Time:Charter Flight Attendant(Atlanta)

No Experience Needed Job

Memphis Hiring:Part-Time Urban Operations Driver

Watch Netflix (Tagger): $12-$46

Boutique Regional Attendant•Buckeye,AZ•Contour Airlines | Hiring

Recruiting:Fulfillment Center-Warehouse Packer in Memphis,TN | Hiring

Cutaneous Oncology Clinical Nurse Educator - So Cal - Remote

Fulfillment Center-Warehouse(PT)-Washington,DC

Amazon 3rd Shift Outbound Fluid Loader

Amazon Warehouse

Tuscaloosa Contract:Warehouse Associate

Amazon Weekend Flex Delivery Driver(Contract)|Fayetteville

Amazon Customer Service - Work From Home $16-$24/hr

Farm Associate - Seasonal / Part Time

Work in Turlock:3rd Shift Fleet Team Lead | Hiring

DNA Evidence Technician I - Lab Operations & Evidence Handling

Nursing Informatics Specialist

Hobby Lobby Work From Home Jobs, Hobby Lobby Hiring Near Me Read More

Amazon Warehouse

Package Handler $15+/ Hour (Sign on Bonus)!

Package Sorter

Amazon Fulfillment Center

Hobby Lobby reputed company Jobs, Hobby Lobby Jobs Remote...

Amazon is hiring a Sortation Warehouse Associate in Dothan | Apply Now

amazon work from home $15+/ Hour (Sign on Bonus!)!

Online Amazon Chat Support Jobs No Experience (REMOTE) - Part-Time at GRAPEVINE MEDIA & MARKETING Modesto, CA

Los Angeles Part-Time Opening:Early Morning Dispatch Driver

Memphis Returns Processing Associate with $16-$18/hr Pay | Hiring

Amazon Delivery Driver

Amazon Fulfillment Center - Warehouse Packer

Remote Customer Service Representative 50k-60k/Year - Work From Home

E-Discovery Evidence Technician: Secure & Track Evidence

Part Time Library Assistant

Water Treatment Technician: Safeguarding Drinking Water

[Work From Home] Hobby Lobby Job Applications Template

Director, Health Plan Dental Solutions

Flexible Seasonal Delivery Associate(Daytona Beach)

Fully Remote Entry Level CSR | No Experience Required

Amazon Content Moderator - Remote Position Available

Lead Flight Attendant

Work From Home Product Tester – $25-$45/hr – No Experience Needed

Entry-Level Apple At Home Advisor – No Experience Required, Work from Home Opportunity with Comprehensive Training and Competitive Pay

Amazon Warehouse - Shopper / Order Fulfillment Associate $17-$23/hr

Director 2, Segment Finance

Remote Online Product Support - No Experience

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...