Maryland Licensed Utilization Specialist

Job Summary

Providing utilization review and denials management for an assigned patient caseload, the part-time Maryland Licensed Utilization Specialist will assess patient needs for outpatient or inpatient care, collaborating with case managers, medical teams, and payers in a remote capacity.

Key responsibilities

• Performs timely and accurate utilization reviews using nationally recognized care guidelines for various patient populations
• Communicates with case managers, physician advisors, and payers regarding reviews and pended/denied days
• Supports the concurrent appeals process by identifying pended/denied days and ensuring appropriate patient status and level of care

Required qualifications

• Bachelor's in Nursing or active pursuit of BSN required; licensure as a Registered Nurse in Maryland preferred
• One year of experience in case management or utilization management preferred
• Knowledge of payer mechanisms and utilization management preferred
• Certified Professional Utilization Reviewer (CPUR) preferred
• Experience in acute care and clinical healthcare settings preferred