Your future role at a glanceLocation: Partially Remote, with onsite coverage required in Baltimore, MD.
Facility: Ascension Saint Agnes Hospital
Department: Utilization Management
Schedule: Day-Shift | Full-Time | Monday-Friday 8:00AM-4:30PM | Weekend Rotation once per month.
Salary range: $81,120.00- $115,939.20 per year
How you'll make an impact in this role- Advocate for appropriate care by reviewing admissions and service requests to ensure every patient receives the right level of medical necessity at the right time.
- Guide complex patient journeys through expert case management and consultation, providing a roadmap for high-quality outcomes in even the most challenging clinical situations.
- Support the frontline care team by resolving documentation and reimbursement hurdles, ensuring the hospital can focus its resources on direct patient care.
- Coordinate seamless transitions by collaborating with the healthcare team to build safe, effective discharge plans that set patients up for success long after they leave our facility.
- Maintain clinical integrity by overseeing compliance with federal and payer regulations, protecting our patients and our organization from administrative risk.
What minimum requirements you'll needLicensure / Certification / Registration:
- Registered Nurse credentialed from the Maryland Board of Nursing obtained prior to hire date or job transfer date required.
Education:
- Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.
What additional preferences we're seeking- Specialized Expertise: Proven experience in Utilization Management, Case Management, or Clinical Documentation Improvement within a healthcare setting.
Responsibilities- Advocate for appropriate care by reviewing admissions and service requests to ensure every patient receives the right level of medical necessity at the right time.
- Guide complex patient journeys through expert case management and consultation, providing a roadmap for high-quality outcomes in even the most challenging clinical situations.
- Support the frontline care team by resolving documentation and reimbursement hurdles, ensuring the hospital can focus its resources on direct patient care.
- Coordinate seamless transitions by collaborating with the healthcare team to build safe, effective discharge plans that set patients up for success long after they leave our facility.
- Maintain clinical integrity by overseeing compliance with federal and payer regulations, protecting our patients and our organization from administrative risk.
QualificationsLicensure / Certification / Registration:
- Registered Nurse credentialed from the Maryland Board of Nursing obtained prior to hire date or job transfer date required.
Education:
- Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.
