Maryland Licensed Utilization Review Nurse

Job Summary

To support efficient patient care, the full-time Maryland Licensed Utilization Review Nurse will conduct initial, concurrent, and retrospective chart reviews, ensuring appropriate resource utilization and coordination to minimize delays and payment denials while working remotely.

Key responsibilities:

• Review medical records using utilization review criteria to assess clinical, financial, and resource consumption
• Coordinate with external reviewers and internal teams to manage certification activities and monitor potential denials
• Document actions taken to coordinate care and assist Care Managers with patient communication 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