Maryland Licensed Utilization Review Nurse

Job Summary

Working remotely in a full-time capacity, the 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 covered services.

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 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 and expertise in utilizing various criteria sets (e.g., InterQual)