Luminis Health
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Utilization Management Nurse
role at
Luminis Health
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
Chart Review:
Review the medical record applying utilization review criteria to assess clinical, financial, and resource utilization; enter clinical review in EPIC; maintain close communication with external reviewers, care coordinators, and providers; reconcile and record authorized days in EPIC.
Denial Management:
Monitor and identify patterns or trends in utilization management; monitor potential and actual denials and collaborate with care coordinator for follow‑up; document actions taken to avoid denial; assist care coordinator in communicating with patients denied hospital days toward resolution and discharge.
Care Coordination:
Collaborate with the care coordinator to achieve optimal and efficient patient outcomes while decreasing length of stay, avoidable delays and denied days; utilize physician advisor and administrative personnel for unresolved issues; identify opportunities for expedited appeals and collaborate with the care coordinator and physician advisor to resolve payer issues.
Process Improvement Initiatives:
Participate in nursing unit and department clinical outcome projects and process improvement initiatives of care management.
Educational/Experience Requirements
Bachelor’s of Science in Nursing or Associate’s degree in Nursing with equivalent experience. BSN must be achieved within 5 years of start date in the role.
Three years of clinical nursing in an acute care hospital setting.
Required Licenses/Certifications
Current RN license from Maryland Board of Nursing.
Working Conditions, Equipment, Physical Demands:
Employees in this position may be exposed to blood‑borne pathogens. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. The physical demands and work environment are representative of those encountered while performing essential functions of this position.
Benefits Overview
Medical, dental, and vision insurance
Retirement plan with employer match for employees who work more than 1000 hours in a calendar year
Paid time off
Tuition assistance benefits
Employee referral bonus program
Paid holidays, disability, and life/AD&D for full‑time employees
Wellness programs
Employee assistance programs
Benefit offerings based on employment status
Pay Range:
$34—$55 USD
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Utilization Management Nurse
role at
Luminis Health
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
Chart Review:
Review the medical record applying utilization review criteria to assess clinical, financial, and resource utilization; enter clinical review in EPIC; maintain close communication with external reviewers, care coordinators, and providers; reconcile and record authorized days in EPIC.
Denial Management:
Monitor and identify patterns or trends in utilization management; monitor potential and actual denials and collaborate with care coordinator for follow‑up; document actions taken to avoid denial; assist care coordinator in communicating with patients denied hospital days toward resolution and discharge.
Care Coordination:
Collaborate with the care coordinator to achieve optimal and efficient patient outcomes while decreasing length of stay, avoidable delays and denied days; utilize physician advisor and administrative personnel for unresolved issues; identify opportunities for expedited appeals and collaborate with the care coordinator and physician advisor to resolve payer issues.
Process Improvement Initiatives:
Participate in nursing unit and department clinical outcome projects and process improvement initiatives of care management.
Educational/Experience Requirements
Bachelor’s of Science in Nursing or Associate’s degree in Nursing with equivalent experience. BSN must be achieved within 5 years of start date in the role.
Three years of clinical nursing in an acute care hospital setting.
Required Licenses/Certifications
Current RN license from Maryland Board of Nursing.
Working Conditions, Equipment, Physical Demands:
Employees in this position may be exposed to blood‑borne pathogens. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. The physical demands and work environment are representative of those encountered while performing essential functions of this position.
Benefits Overview
Medical, dental, and vision insurance
Retirement plan with employer match for employees who work more than 1000 hours in a calendar year
Paid time off
Tuition assistance benefits
Employee referral bonus program
Paid holidays, disability, and life/AD&D for full‑time employees
Wellness programs
Employee assistance programs
Benefit offerings based on employment status
Pay Range:
$34—$55 USD
#J-18808-Ljbffr