Care Utilization & Denials Specialist

University of Maryland Medical System; Baltimore (MD); On-site; USD 90,000 - 120,000; Full time

Job summary

The University of Maryland Medical System is seeking a nurse with utilization review expertise to assess patient care levels and appropriate resource use. You will collaborate with case managers, physicians, and payers to optimize outcomes and maintain compliance.

Responsibilities include performing reviews, supporting the appeals process, and ensuring accurate documentation for inpatient, observation, and other care settings. Strong analytical skills and communication are essential.

Qualifications

• Knowledge of utilization management processes and guidelines.
• Excellent verbal and written communication with physicians and teams.
• Ability to analyze data and prioritize workload in a fast-paced hospital setting.

Responsibilities

• Perform timely utilization review for diverse patient populations.
• Communicate with case manager, medical team, and payers regarding reviews.
• Support concurrent appeals with referrals and documentation.
• Ensure appropriate level of care and patient status for each case.
• Stay current on clinical practices affecting reimbursement and compliance.

Skills

Utilization management knowledge

Verbal and written communication

Analytical skills

Team collaboration

Education

Registered Nurse license (Maryland)

Job description

The University of Maryland Medical System is seeking a nurse with utilization review expertise to assess patient care levels and appropriate resource use. You will collaborate with case managers, physicians, and payers to optimize outcomes and maintain compliance.

Responsibilities include performing reviews, supporting the appeals process, and ensuring accurate documentation for inpatient, observation, and other care settings. Strong analytical skills and communication are essential.