Maryland Licensed Utilization Nurse Reviewer

Company: VirtualVocations
Location: Sunnyvale
Posted on: March 9, 2025

Job Description:

A company is looking for a Utilization Nurse Reviewer (Remote), Day Shift, Utilization Management.
Key Responsibilities

Conduct clinical chart reviews and communicate with third-party payers regarding medical necessity and compliance
Promote quality care by reviewing hospital resource utilization and suggesting improvements for challenging Diagnosis Related Groups (DRGs)
Maintain effective relationships with internal and external stakeholders, assisting with troubleshooting and denial resolution

Required Qualifications and Education

3-5 years of experience in acute care case management or utilization management activities
Knowledge of InterQual/Milliman and CMS guidelines
Current certification in Utilization Management/Case Management, preferably in an acute care setting
RN-BSN preferred; RN-AA acceptable with relevant experience
DC or MD nursing license required based on assignment

Keywords: VirtualVocations, Sunnyvale , Maryland Licensed Utilization Nurse Reviewer, Healthcare , Sunnyvale, California

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