Utilization Review Nurse RN
Proforma Health · Baltimore, MD · 2 wk ago
HealthcareFull-time
About the Role
The Utilization Review Nurse RN evaluates the medical necessity of patient stays, coordinates with physicians and payors to optimize resource utilization, minimize denials, and ensure appropriate reimbursement.
Responsibilities
- Conduct medical necessity reviews of hospital stays and refer cases to physician advisors as needed
- Manage denials by collaborating with Case Management and other stakeholders
- Monitor and assess hospital resource utilization to promote efficiency
Requirements
- ADN or higher nursing degree
- Current RN license (Maryland or Multistate)
- Minimum of 2 years of acute inpatient utilization review experience
Preferred Qualifications
- BSN
Schedule
Full-time, day shift (8:00 am – 4:30 pm) with weekend commitment.
Benefits
- Health plans
- Wellness programs
- Opportunities for professional growth, education, and skill development in a collaborative environment