Utilization Management Coordinator

University of Maryland Medical System·Glen Burnie, Maryland

Full Time On Site 2-5 yrsPosted 6 days ago

About the role

The Utilization Management Coordinator performs timely utilization reviews to assess patient care needs and appropriate levels of care. They also manage denials, support the concurrent appeals process, and collaborate with medical teams to ensure regulatory compliance and optimal reimbursement.

Job Requirements Under general supervision, provides utilization review and denials management for an assigned patient case load. This role utilizes nationally recognized care guidelines/criteria to assess the patient’s need for outpatient or inpatient care as well as the appropriate level of care. The role requires interfacing with the case managers, medical team, other hospital staff, physician advisors and payers.

Work Experience The following statements are intended to describe the general nature and level of work being performed by staff assigned to this classification.

They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

Performs timely and accurate utilization review for all patient populations, using nationally recognized care guidelines/criteria relevant to the payer.

Communicates with case manager, physician advisor, medical team and payors as needed regarding reviews and pended/denied days and interventions.

Supports concurrent appeals process through proactive identification of pended/denied days.

Implements the concurrent appeals process with appropriate referrals and documentation.

Ensures appropriate Level of Care and patient status for each patient (Observation, Extended Recovery, Administrative, Inpatient, Critical Care, Intermediate Care, and Med-Surg) 5.

Reviews tests, procedures and consultations for appropriate utilization of resources in a timely manner Education and Experience 1.

Licensure as a Registered Nurse or other equivalent health care license in the state of Maryland, or eligible to practice due to Compact state agreements outlined through the MD Board of Nursing, is required.

Knowledge, Skills and Abilities

1. Knowledge of utilization management is preferred. 2. Highly effective verbal and written skills are required. 3. Strong communication skills, self-confidence and experience in working with physicians are required. 4. Excellent analytical and team building skills, as well as the ability to prioritize and work independently are required. 5. The ability to work collaboratively with other disciplines is required. 6. Ability to work with Hospital/ Utilization Management and related software programs is required. 6. HINN discussions/Observation Education 7. Assists Case Manager in Avoidable Days Collection 8. Ownership of Regulatory Compliance related to Utilization Management conditions of participation 9. Assures appropriate reimbursement and stewardship of organizational and patient resources. 10. Actively reports opportunities to improve reimbursement and responds to relevant data 11. Collaborates with admitting specialists regarding authorization policies and procedures of third party payers. 12. Remains current on clinical practice and protocols impacting clinical reimbursement

Requirements

Candidates must hold a valid Registered Nurse license or equivalent healthcare license in Maryland. Strong communication, analytical skills, and experience working with physicians and utilization management software are required.

professional certificate
Communication
Analytical skills
Regulatory compliance
Interdisciplinary collaboration
Team building
Resource utilization
Clinical documentation
Utilization management
Software proficiency
Denials management
Reimbursement management
Appeals process
Patient status assessment
Care guidelines
Authorization policies

Posting details

Employment type: Full Time
Work arrangement: On Site
Experience: 2-5 yrs
Location: Glen Burnie, Maryland
Posted: Sep 11, 2026
Application: Employer website

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Utilization Management Coordinator

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About the role

Knowledge, Skills and Abilities

Requirements

Posting details

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Maryland medical office admin roles stay steady

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