Utilization Management RN (Remote) | Baltimore, MD |

Job Title: Utilization Management RN (Remote) Baltimore MD $85K

Fully remote opportunity
Fast interview process

Location: Baltimore MD (Remote must reside in Maryland or hold compact license)
Job Type: Full-Time
Department: Utilization Management

About Us
Morgan Stephens represents the nations top healthcare systems offering highly competitive compensation and benefits to top candidates. We are led by experienced healthcare industry professionals and specialize in contract contract-to-hire and direct placement services nationwide.

We have successfully placed thousands of healthcare professionals into organizations seeking high-quality talent and continue to partner with leading health systems and managed care organizations.

Position Summary
The Utilization Management RN plays a critical role in ensuring healthcare services are delivered with quality cost efficiency and full regulatory compliance. Through ongoing review and audit of clinical documentation this role helps prevent unnecessary procedures ineffective treatment and extended hospital stays.

This position is ideal for an RN with strong clinical judgment prior authorization experience and a background in managed care hospital case management or utilization review.

Job Duties and Responsibilities

Perform concurrent review of patient clinical information for medical necessity and efficiency

Conduct ongoing review of precertification and prior authorization requests

Ensure services align with established clinical guidelines (MCG or InterQual)

Monitor the activities of clinical and non-clinical staff related to utilization processes

Coordinate discharge planning needs with the interdisciplinary healthcare team

Advocate for quality care and improved patient outcomes

Identify opportunities to reduce unnecessary hospital stays and prevent complications

Maintain accurate and timely documentation of all patient-related interactions

Prepare reports on patient management utilization trends and cost savings

Provide daily updates to the Manager of Utilization Management

Work effectively in a fast-paced high-volume environment with minimal supervision

Skills and Qualifications

Active unrestricted Registered Nurse (RN) license in Maryland or compact state (required)

Bachelors degree in Nursing (BSN preferred)

Minimum of 2 years of experience in Utilization Management or Case Management

Strong knowledge of MCG or InterQual guidelines

Experience with prior authorizations concurrent review and medical necessity determinations

Proficiency in EMR systems and Microsoft Office (Excel Word Outlook)

Strong critical thinking organizational and communication skills

Ability to work independently in a fully remote environment

Preferred Experience

Managed care or health plan experience (Medicaid or Medicare populations preferred)

Experience with Maryland Medicaid or long-term services and supports (LTSS)

Utilization Management (UM) or Case Management certification (CCM ACM) preferred

Why This Role Matters
This role directly impacts patient outcomes cost efficiency and quality of care. You will play a key role in ensuring patients receive appropriate timely and effective treatment while supporting the overall healthcare system.

Benefits Include
Competitive compensation full benefits package 401(k) with match paid time off continuing education support and full remote flexibility.