Utilization Review Nurse

To ensure clinically appropriate hospital stays and optimize resource use, the full-time Maryland Licensed Utilization Review Nurse will conduct initial, concurrent, and retrospective chart reviews while coordinating with third-party payers and internal teams to minimize delays and payment denials in a remote capacity. Key responsibilities: Review medical records using utilization review criteria to assess clinical and resource utilization Coordinate with Care Managers and external reviewers to manage denials and ensure timely patient services Document actions taken to avoid payment denials and assist in the appeals process as needed Required qualifications: Education: BSN preferred; ADN required Experience: 3-5 years of Utilization Review experience, preferably in an acute hospital setting Licensure: Current Maryland Registered Nurse License or eligibility to obtain one