Maryland Licensed Utilization Management RN

Job Summary

A company is looking for a Utilization Management RN (Remote).

Key Responsibilities

• Perform concurrent reviews of patient clinical information for medical necessity and efficiency
• Conduct ongoing reviews of precertification and prior authorization requests
• Advocate for quality care and improved patient outcomes while coordinating discharge planning needs

Required Qualifications

• Active, unrestricted Registered Nurse (RN) license in Maryland or compact state
• Bachelor's 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 and medical necessity determinations