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Patrica, RN

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Patricia, RN
Med-Surg Nurse

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Luminis Health

Utilization Management Nurse - ED Point of Entry - Part Time

Annapolis, Maryland

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As a Utilization Management Nurse - ED Point of Entry - Part Time you'll take your nursing experience to the next level by developing, coordinating and overseeing holistic care plans that help our patients live their healthiest lives. In this highly collaborative role, you'll work closely with your colleagues, patients and their families to assess needs and determine the best course of action. By interacting with all areas of our hospital system, you'll play a key role in our mission to deliver comprehensive and culturally informed care to our communities.

Success Profile

Success Profile

a great Utilization Management Nurse - ED Point of Entry - Part Time is...

  • Organized
  • Goal-oriented
  • Analytical
  • Quick-thinking
  • Motivational
  • Team player

Culture

When you become a Luminary, you’ll be part of a team that embraces your authentic self, supports your wellbeing, and empowers you to help build a more inclusive world.

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Luminis Health

Utilization Management Nurse - ED Point of Entry - Part Time

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Job #: SMB-57306 Category: Luminis Health Location: Annapolis, MD Posted date: Jun. 25, 2025

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:

1. 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

2. 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.

3. 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.

4.  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

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“We have such a phenomenal atmosphere here at Luminis Health Anne Arundel Medical Center. Our R.I.S.E values have set the foundation for our culture here at LHAAMC. Each and every day it's an honor to have the opportunity to greet, serve, and exceed our expectations here at Luminis Health.”

Russell Lewis Jr Customer Information Assistant at LHAAMC

“I provide the personal touch to patients and their families, so they can get through this medical journey with as few barriers as possible.”

Teresa Putscher Nurse Navigator

“Teamwork is very important. Everyone’s role is integral to the success of treating a patient.”

Dr. Nancy Clark Chief of Vascular Surgery

“I look forward to providing a high level of care to patients. That’s what gets me out of bed in the morning.”

Dr. Naeem Newman Surgeon
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