Utilization Management Specialist II, Experienced

University of Maryland Medical System • Baltimore, MD

9d • $39 - $58

About The Position

Under general supervision, provides utilization review and denials management for an assigned patient case load. This role utilizes nationally recognized care guidelines/criteria to assess the patient’s need for outpatient or inpatient care as well as the appropriate level of care. The role requires interfacing with the case managers, medical team, other hospital staff, physician advisors and payers.

Requirements

• Licensure as a Registered Nurse or other equivalent health care license in the state of Maryland, or eligible to practice due to Compact state agreements outlined through the MD Board of Nursing, is Required
• Minimum of 12 months experience in case management or utilization management required

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 1,001-5,000 employees