Utilization Review Nurse RN
Health Here · Baltimore, MD · 6 days ago
HealthcareFull-time
Responsibilities
- Conducts concurrent and retrospective reviews to ensure appropriate care levels, medical necessity, and compliance.
- Collaborates with physicians, care managers, and payers to secure authorizations, prevent denials, and facilitate safe, timely care transitions.
- Applies InterQual/MCG criteria, documents in EMR, identifies discharge barriers, and educates teams on utilization standards.
Qualifications & Skills
- Active Nursing RN license.
- Strong knowledge of utilization review processes, regulatory requirements, and clinical documentation.
- Excellent communication and collaboration skills.
- Attention to detail and ability to interpret medical criteria.
- Experience coordinating with multidisciplinary teams.