RN Case Manager Utilization Review
Company: MedStar Health
Location: Rosedale
Posted on: March 1, 2026
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Job Description:
MedStar Health, a leading not-for-profit healthcare organization
in the DMV area, is looking for a dedicated and compassionate RN
Case Manager specializing in Utilization Review to join our team.
In this role, you will be essential in managing patient care
coordination, ensuring that all patients receive the necessary care
within the appropriate setting and time frame. Utilizing both your
clinical expertise and knowledge of healthcare policies, you will
review treatment plans and determine the necessity and efficiency
of services, all while upholding our patient-first philosophy.
Assess patient care needs and develop care plans in collaboration
with healthcare providers. Perform initial patient assessments and
ongoing reassessments based on protocols and standards of care.
Determine the appropriateness of inpatient and outpatient services
following evidence-based guidelines. Collaborate with
multidisciplinary teams to ensure effective communication between
all caregivers and patients. Monitor patient progress and adjust
care plans as necessary. Educate patients and families about
treatment options and healthcare rights. Ensure compliance with
federal, state, and local regulations and accreditation
requirements. Document and maintain accurate records of patient
interactions and decisions. Strong clinical judgment Proficiency in
utilization review and case management software Excellent
communication and interpersonal skills Ability to work effectively
in a multidisciplinary team Knowledge of healthcare regulations and
accreditation standards Medical Insurance Dental Insurance Vision
Insurance Life Insurance 401k Current Registered Nurse (RN) license
in the state of practice Certification in Case Management (CCM)
preferred
Keywords: MedStar Health, Baltimore , RN Case Manager Utilization Review, Healthcare , Rosedale, Maryland
