Maryland Licensed Utilization Review Nurse

Job Summary

To ensure high-quality patient care and appropriate admit status, the full-time Maryland Licensed Utilization Review Nurse will conduct admission concurrent and retrospective case reviews, collaborate with medical staff, and manage documentation and communication with third-party payors in a remote work environment.

Key responsibilities

• Conduct admission concurrent and retrospective case reviews to meet hospital objectives
• Collaborate with medical staff and ancillary disciplines to address patients' healthcare needs efficiently
• Perform medical record reviews and communicate with third-party payors to ensure proper reimbursement

Required qualifications

• Associate's degree in Nursing required; Bachelor's degree preferred
• 3-4 years of experience in an acute care setting required
• 2 years of experience in case management, insurance utilization review, or related fields required
• RN - Registered Nurse licensure in Maryland or compact state required
• CCM - Certified Case Manager preferred