Maryland Licensed Utilization Specialist

Job Summary

Providing utilization review and denials management for an assigned patient case load, the PRN Maryland Licensed Utilization Specialist will work remotely to assess patient needs for care, communicate with medical teams and payers, and support the concurrent appeals process.

Key responsibilities

• Performs timely and accurate utilization reviews using nationally recognized care guidelines
• Communicates with case managers, physician advisors, and payers regarding reviews and pended/denied days
• Ensures appropriate level of care and patient status for each patient while collaborating with admitting specialists on authorization policies

Required qualifications

• Bachelor's in Nursing or active pursuit of BSN required
• Licensure as a Registered Nurse in Maryland or eligibility to practice under Compact state agreements preferred
• One year of experience in case management or utilization management preferred
• Two years of experience in acute care and four years of clinical healthcare experience preferred
• Certified Professional Utilization Reviewer (CPUR) preferred