Utilization Review Nurse

To ensure appropriate resource utilization and minimize payment denials, the full-time remote Maryland Licensed Utilization Review Nurse will conduct initial, concurrent, and retrospective chart reviews while coordinating with healthcare teams and third-party payers. Key responsibilities: Review medical records using utilization review criteria to assess clinical and financial resource consumption Maintain communication with external reviewers and perform certification activities as required by payors Document actions taken to coordinate care, avoid denials, and assist in communicating with patients regarding discharge plans Required qualifications: ADN required; BSN preferred 3-5 years of Utilization Review experience, preferably in an acute hospital setting Current Maryland Registered Nurse License or eligibility to obtain