Maryland Licensed Utilization Review RN

Job Summary

A company is looking for a Utilization Review Registered Nurse (RN).

Key Responsibilities

• Conducts admission concurrent and retrospective case reviews to ensure appropriate admit status and level of care
• Collaborates with medical staff and ancillary hospital disciplines to meet patients' health care needs efficiently
• Performs medical record reviews and communicates with third-party payors to ensure proper hospital reimbursement

Required Qualifications

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