Clinical Utilization Specialist

19 hours ago


Upper Marlboro, Maryland, United States University of Maryland Medical System Full time
Company Overview

The University of Maryland Medical System is a leading healthcare provider in the region, committed to delivering high-quality patient care and advancing medical research. Our state-of-the-art regional medical center in Largo, MD, serves as a tertiary care center for critically ill patients and offers improved access to primary and ambulatory care services.

We are seeking a highly skilled Utilization Reviewer to join our team. As a key member of our case management team, you will play a critical role in ensuring that patients receive the most appropriate level of care while minimizing unnecessary resource utilization.

Job Summary

The Utilization Reviewer will be responsible for performing timely and accurate utilization reviews for all patient populations, using nationally recognized care guidelines/criteria relevant to the payer. This will involve communicating with clinical care coordinators, physician advisors, medical teams, and payers as needed regarding reviews and pended/denied days and interventions.

The ideal candidate will have a strong understanding of utilization management principles and practices, as well as excellent analytical and communication skills. If you are a motivated and detail-oriented professional looking to make a meaningful contribution to our organization, we encourage you to apply for this exciting opportunity.

About You

To be successful in this role, you will need to possess a bachelor's degree in nursing and be licensed as a registered nurse in the state of Maryland or eligible to practice due to compact state agreements outlined through the MD Board of Nursing. One year of experience in case management or utilization management with knowledge of payer mechanisms and utilization management is preferred. Additionally, certified professional utilization reviewer (CPUR) certification is highly desirable.

As a member of our team, you will enjoy a competitive salary range of $51.55-$57.62 per hour, along with comprehensive benefits and opportunities for professional growth and development. If you are passionate about delivering exceptional patient care and advancing the field of healthcare, we invite you to explore this exciting opportunity further.

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