Registered Nurse (RN) – Utilization Review (UR)


Johns Hopkins Hospital


Baltimore City, MD

Contract Terms

Registered Nurse (RN) – Utilization Review (UR)
Johns Hopkins Hospital

Currently seeking a RN to work in Utilization Review for a 13 week assignment (with possible extension) in Baltimore, MD. The ideal candidate will have at least 2 years clinical experience and 1 years of specialty experience.


RN Utilization Management Experience:

Responsibilities & Duties-

Office based

Summary: The Utilization Review Nurse performs utilization review of all patients presenting for hospitalization to assist in identifying patients appropriate for admission to inpatient, observation, or other patient care status. We conduct continued stay review evaluating the medical necessity, appropriateness and efficient use of health care services of all hospitalizations, inpatient or outpatient. The Utilization Review Nurse collaborates with physicians, the health care team and care coordinator to optimally certify the level of care and facilitate the patient’s movement through the continuum of care as appropriate.

Essential Duties and Responsibilities

  • Demonstrates expertise in the application of InterQual and Milliman criteria.
  • Reviews of clinical data for ED admits,
  • Manages all direct admits, clarifying level of care orders and performing Milliman/InterQual screening as appropriate. Acquires additional information if necessary to assist in level of care determination.
  • Insures operative procedure performed is the operative procedure prior-authorized with the third party payor and communicates any variance.
  • Performing clinical reviews of all inbound transfers for appropriateness.
  • Monitors use of healthcare resources. Communicates with physicians to assure patient receives diagnostics/evaluations in the proper setting, i.e. inpatient vs outpatient
  • Maintains current knowledge of CMS (Medicare) rules and regulations.
  • Communicates openly with third party payors and works collaboratively with them to avoid concurrent denials.
  • Collaborates with the care coordinator to ensure appropriate level of care,
  • Actively participates in the multidisciplinary team meetings
  • Identifies and documents delays in service
  • Serves as an expert resource to physicians and healthcare staff in the application of InterQual and Milliman criteria and the use of evidence based practices.
  • Conducts initial (admission) reviews at the time of presentation, or within 24 hours, if patient presents during uncovered hours.
  • Conducts concurrent review per department policy (every three days for Medicare unless the patient condition changes), and as private payor dictates.
  • Conducts observation reviews daily.
  • Follows department policy regarding escalation of utilization issues to the Physician Advisor or his/her designee.

Shift – 8 hour days
Full-time Starting ASAP
13 weeks with possible extension.
For immediate consideration, please send your resume via email to

Shift Time



Every other weekend/holiday


Float As Needed

Pay Rate

$35 / Hour

Skill Set Requirements

Must have at least 2 years of clinical experience and 1 year in the specialty requested.
Registered Nurse (RN) – Utilization Review (UR)

Profile Requirements

Require an updated resume, skills checklist, and two recent manager or supervisory references. Please note these are the standard requirements but they can vary by facility. Need active MD or compact license.

Rate Details

Please note: Quoted pay rate is for local candidates. Travelers will be paid the equivalent of the local rate minus housing. Housing stipends available. Please note orientation is paid at full rate and parking is reimbursed. Travelers please request a sample pay stub to know to see your take home wage.

If you are interested in this position, please complete an electronic application here. We will contact you as soon as possible to discuss this position, as well as all other contract and per diem positions of interest, available with Chesapeake Medical Staffing.

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