Maryland Licensed Utilization Review Nurse

Job Summary

To ensure appropriate resource utilization and minimize payment denials, the full-time remote Maryland Licensed Utilization Review Nurse will conduct initial, concurrent, and retrospective chart reviews while coordinating with healthcare teams and third-party payers.

Key responsibilities:

• Review medical records using utilization review criteria to assess clinical and financial resource consumption
• Maintain communication with external reviewers and perform certification activities as required by payors
• Document actions taken to coordinate care, avoid denials, and assist in communicating with patients regarding discharge plans

Required qualifications:

• ADN required; BSN preferred
• 3-5 years of Utilization Review experience, preferably in an acute hospital setting
• Current Maryland Registered Nurse License or eligibility to obtain