Maryland Licensed Utilization Specialist

Job Summary

Working remotely on a full-time basis, the Maryland Licensed Utilization Specialist will perform admission reviews, concurrent reviews, and retrospective chart reviews to assess clinical performance and manage utilization issues affecting patient reimbursement.

Key responsibilities

• Conduct admission, concurrent, and retrospective reviews of medical records
• Provide clinical information to payers and collaborate with clinical teams and Physician Advisors
• Collect and report UM data, and design special projects as directed by the UM Team Manager

Required qualifications

• Completion of an accredited Nursing Program (RN) or LCSW required; BSN preferred
• Minimum of five years of nursing or licensed social work experience, preferably in Utilization Management or Care Management
• Valid state Nursing licensure or Social Work License for Psychiatry required