Utilization Review, RN Flex

University of Maryland Medical System; Towson (MD); On-site; USD 60,000 - 80,000; Part time

Job summary

University of Maryland Medical System seeks a Utilization Review Nurse for weekend shifts in Towson, MD. The role bridges care teams and insurers, ensuring medical necessity and appropriate care levels while supporting prior authorizations.

You will work with UR/MCG guidelines, requiring strong verbal and written communication, Excel and Word proficiency, and nursing credentials. Training is partly remote with onsite start as needed.

Qualifications

• Bachelor's degree in Nursing required.
• UR/MCG experience required.
• Strong verbal and written communication skills.
• Proficient in Excel, PowerPoint and Word.

Responsibilities

• Perform medical necessity reviews by comparing patient charts to guidelines.
• Submit clinical data to insurance for prior authorizations and approvals.
• Coordinate discharges and optimize level of care (observation vs. inpatient).
• Act as liaison between healthcare providers and insurers to prevent denials and ensure reimbursement.

Skills

Verbal communications

Written communications

Excellent organizational skills

Recent UR / MCG experience

Education

Bachelor's degree in Nursing

Master's Degree in Nursing (Preferred)

Tools

Excel

PowerPoint

MS Word

Job description

• 4 - eight hour weekend shifts a month required.
• At least 1 major holiday required.
• Only serious applicants should apply.
• Recent UR / MCG experience.
• Most of the training will be remote however you will be required to start onsite

Job Requirements

• Weekend only position.
• 4 - eight hour weekend shifts a month required.
• At least 1 major holiday required.
• Only serious applicants should apply.
• Recent UR / MCG experience.
• Most of the training will be remote however you will be required to start onsite

A Utilization Review (UR) Nurse is a registered nurse who bridges the gap between healthcare providers and insurance companies. They evaluate patient medical records to ensure treatments, procedures, and hospital stays are clinically necessary, cost-effective, and meet established insurance guidelines.

• Medical Necessity Reviews: They verify that admissions, surgeries, and treatments are medically necessary by comparing patient charts to standardized, evidence-based guidelines like Milliman Care Guidelines (MCG) or InterQual.
• Concurrent & Retrospective Reviews: They review ongoing hospital stays (concurrent) to authorize continuing care, and review charts after discharge (retrospective) to prevent claim denials and ensure accurate billing.
• Insurance Liaison: They act as a go-between, submitting clinical data to insurance companies to secure prior authorizations and ongoing approvals so the hospital gets properly reimbursed.
• Resource Optimization: They monitor the patient's progress to ensure they are in the appropriate level of care (e.g., observation vs. inpatient) and help coordinate discharges to lower levels of care.

Work Experience

Education

• 4 year/ Bachelor's degree in Nursing (Required)

Master's Degree In Nursing (Preferred)

Experience and Skills

Recent UR / MCG experience. Required Skills: Strong Verbal Communications Skills, Strong Written Communications Skills, Excel Intermediate Level, PowerPoint - Intermediate Level, MS Word - Intermediate Level, Excellent Organizational Skills