Nurse Utilization Manager

3 days ago


Baltimore, Maryland, United States Centurion Managed Care Full time

Job Details

Description

We are seeking a skilled Nurse Utilization Manager to join our Maryland Regional Office Team. The successful candidate will be responsible for reviewing requests for prior authorization of medical services, ensuring medical necessity and appropriate level of care. This includes admissions through on-site and telephonic review, as well as reviewing and auditing patient medical records to determine medical necessity. The Nurse Utilization Manager will also assist with completing Medicaid applications for patients currently hospitalized and serve as a clinical resource and liaison for site and hospital referral staff.

Responsibilities

  • Review requests for prior authorization of medical services
  • Ensure medical necessity and appropriate level of care
  • Perform on-site and telephonic admissions reviews
  • Review and audit patient medical records
  • Assist with completing Medicaid applications
  • Serve as a clinical resource and liaison for site and hospital referral staff

Qualifications

  • MD or compact RN license
  • Utilization management experience, InterQual experience preferred
  • Two (2) years of clinical nursing experience and one year of experience in performing prior authorization review
  • Experience using medical management software programs
  • Experience working with a correctional institution or agency preferred
  • Must be able to pass background investigation and obtain agency security clearance

Benefits

  • Health, dental, vision, disability, and life insurance
  • 401(k) with company match
  • Generous paid time off
  • Paid holidays
  • Flexible Spending Account
  • Continuing Education benefits

About Centurion Managed Care

Centurion Managed Care is a leading provider of healthcare services, dedicated to delivering high-quality care to our patients. We are committed to providing a supportive and inclusive work environment that allows our employees to grow and thrive. If you are a motivated and experienced Nurse Utilization Manager looking for a new challenge, we encourage you to apply for this exciting opportunity.

Estimated Salary

$85,000 - $110,000 per year, depending on experience.



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