Maryland Licensed Utilization Review Nurse

Job Summary

Working remotely on a full-time basis, a Maryland Licensed Utilization Review Nurse will monitor the appropriateness of care for plan members, evaluate benefits and medical criteria for service authorization, and communicate decisions regarding coverage.

Key responsibilities

• Monitor the appropriateness of care received by plan members in various settings
• Evaluate member benefits and medical criteria to determine authorization of services
• Initiate discharge planning for members and communicate authorization or denial of services

Required qualifications

• Unencumbered Registered Nurse (RN) license in Maryland or a Compact state
• 3+ years of experience as an acute care RN
• 1+ years of experience in Managed Care/Utilization Review
• Understanding of managed care delivery systems and utilization management
• Knowledge of various criteria sets, such as InterQual