Utilization Review & Denials Specialist

University of Maryland Medical System; Glen Burnie (MD); On-site; USD 85,000 - 110,000; Full time

Job summary

The University of Maryland Medical System is seeking a utilization review professional to oversee case loads, applying nationally recognized care guidelines to determine outpatient or inpatient level of care, and coordinating with case managers, medical teams, and payers.

Under supervision, you will support deny management, documentation, and appeals, ensuring compliant utilization and appropriate reimbursement while collaborating with physicians and hospital staff.

Qualifications

• Licensure as a Registered Nurse in Maryland or eligible via compact state.
• Strong verbal and written communication skills are required.
• Experience in utilization management and working with clinicians is preferred.

Responsibilities

• Performs timely utilization review for all patient populations using care guidelines.
• Communicates with case managers, medical teams, and payers on reviews and denials.
• Supports concurrent appeals and documentation for pended/denied days.
• Ensures appropriate Level of Care and patient status for each case.
• Reviews tests and procedures for appropriate resource utilization.

Skills

Utilization management

Communication skills

Analytical skills

Team collaboration

Education

RN license (MD or compact eligibility)

Tools

EMR systems

Job description

The University of Maryland Medical System is seeking a utilization review professional to oversee case loads, applying nationally recognized care guidelines to determine outpatient or inpatient level of care, and coordinating with case managers, medical teams, and payers.

Under supervision, you will support deny management, documentation, and appeals, ensuring compliant utilization and appropriate reimbursement while collaborating with physicians and hospital staff.