Luminis Health
Join to apply for the
Utilization Management Nurse
role at
Luminis Health Join to apply for the
Utilization Management Nurse
role at
Luminis Health Get AI-powered advice on this job and more exclusive features. 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:
Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource utilization; enters clinical review in EPIC; maintains close communication with external reviews, care coordinators, and providers; reconciles and records days authorized in EPIC
Denial Management:
Monitors and identifies patterns or trends in utilization management; monitors potential and actual denials and collaborates with care coordinator for any follow up necessary; documents actions taken to avoid denial; assists Care Coordinator in communicating with the patient denied hospital days with work toward resolution and discharge.
Care Coordination:
Collaborates with the Care Coordinator to achieve optimal and efficient patient outcomes while decreasing length of stay, avoidable delays and denied days; utilizes Physician Advisor and administrative personnel for unresolved issues; identifies opportunities for expedited appeals and collaborates with the care coordinator and Physician Advisor to resolve payer issues.
Process improvement initiatives
Participates in nursing unit and department clinical outcome projects as well as 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.
RequiredLicense/Certifications
Current RN license from Maryland Board of Nursing.
Working Conditions, Equipment, Physical Demands
There is a reasonable expectation that employees in this position will be exposed to blood-borne pathogens.
Physical Demands -
The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.
The above job description is an overview of the functions and requirements for this position. This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.
Pay Range
$34—$55 USD
Luminis Health 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 and more Benefit offerings based on employment status
Opt-in for text notifications!
Luminis Health's two-way SMS texting platform lets you receive notifications and messages from our Talent Acquisition team directly on your phone.
To enable this feature, select "yes" when asked to "opt-in to receive text messages" and to "Receive updates from a recruiter about this job via SMS" when completing your application. Once you are opted in, you can easily opt-out at any time.
Standard text messaging rates may apply based on the candidate's mobile carrier plan. Luminis Health is not responsible for any charges incurred by the recipient. Candidates are encouraged to review their mobile carrier's plan for applicable text messaging rates and usage charges. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
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Utilization Management Nurse
role at
Luminis Health Join to apply for the
Utilization Management Nurse
role at
Luminis Health Get AI-powered advice on this job and more exclusive features. 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:
Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource utilization; enters clinical review in EPIC; maintains close communication with external reviews, care coordinators, and providers; reconciles and records days authorized in EPIC
Denial Management:
Monitors and identifies patterns or trends in utilization management; monitors potential and actual denials and collaborates with care coordinator for any follow up necessary; documents actions taken to avoid denial; assists Care Coordinator in communicating with the patient denied hospital days with work toward resolution and discharge.
Care Coordination:
Collaborates with the Care Coordinator to achieve optimal and efficient patient outcomes while decreasing length of stay, avoidable delays and denied days; utilizes Physician Advisor and administrative personnel for unresolved issues; identifies opportunities for expedited appeals and collaborates with the care coordinator and Physician Advisor to resolve payer issues.
Process improvement initiatives
Participates in nursing unit and department clinical outcome projects as well as 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.
RequiredLicense/Certifications
Current RN license from Maryland Board of Nursing.
Working Conditions, Equipment, Physical Demands
There is a reasonable expectation that employees in this position will be exposed to blood-borne pathogens.
Physical Demands -
The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.
The above job description is an overview of the functions and requirements for this position. This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.
Pay Range
$34—$55 USD
Luminis Health 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 and more Benefit offerings based on employment status
Opt-in for text notifications!
Luminis Health's two-way SMS texting platform lets you receive notifications and messages from our Talent Acquisition team directly on your phone.
To enable this feature, select "yes" when asked to "opt-in to receive text messages" and to "Receive updates from a recruiter about this job via SMS" when completing your application. Once you are opted in, you can easily opt-out at any time.
Standard text messaging rates may apply based on the candidate's mobile carrier plan. Luminis Health is not responsible for any charges incurred by the recipient. Candidates are encouraged to review their mobile carrier's plan for applicable text messaging rates and usage charges. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
Job function Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at Luminis Health by 2x Get notified about new Nurse jobs in
Lanham, MD . Washington, DC $61,470.00-$130,000.00 3 months ago Telehealth Registered Nurse- REMOTE September 2025
Washington, DC $61,000.00-$130,000.00 4 months ago Silver Spring, MD $40.00-$41.00 1 month ago Bethesda, MD $61,000.00-$128,000.00 3 months ago Annapolis, MD $60,000.00-$121,000.00 1 month ago Columbia, MD $61,000.00-$128,000.00 3 months ago Registered Nurse - Clinical Denials/Appeals - Remote
District of Columbia, United States $68,000.00-$113,000.00 6 days ago New Grad RN, October 2025 Residency Program - All specialties
Registered Nurse (RN), PreOp, Part time, $12k Sign on Bonus
Registered Nurse (RN), Day Shift, Home Health
Silver Spring, MD $60,420.00-$106,040.00 5 months ago Maryland, United States $71,100.00-$97,800.00 3 days ago Registered Nurse (RN) - Occupational Health
Washington, DC $61,000.00-$128,000.00 3 months ago Falls Church, VA $1,922.77-$1,922.77 8 months ago Permanent Staff New Graduate RN job in Lanham, MD - Make $25 to $35/hour
Falls Church, VA $1,922.77-$1,922.77 8 months ago Permanent Staff New Graduate RN job in Lanham, MD - Make $25 to $35/hour
Falls Church, VA $1,922.77-$1,922.77 8 months ago Permanent Staff New Graduate RN job in Lanham, MD - Make $25 to $35/hour
Falls Church, VA $1,922.77-$1,922.77 8 months ago Permanent Staff New Graduate RN job in Lanham, MD - Make $25 to $35/hour
Falls Church, VA $1,922.77-$1,922.77 8 months ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr