Maryland Licensed Utilization Review Nurse

Job Summary

To ensure clinically appropriate hospital stays and optimize resource use, the full-time Maryland Licensed Utilization Review Nurse will conduct initial, concurrent, and retrospective chart reviews while coordinating with third-party payers and internal teams to minimize delays and payment denials in a remote capacity.

Key responsibilities:

• Review medical records using utilization review criteria to assess clinical and resource utilization
• Coordinate with Care Managers and external reviewers to manage denials and ensure timely patient services
• Document actions taken to avoid payment denials and assist in the appeals process as needed

Required qualifications:

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