Utilization Review Management Specialist - Hybrid

Contract: Baltimore, Maryland, US

Salary Range: 40.00 - 49.00 | Per Hour

Job Code: 360027

End Date: 2025-04-17

Days Left: 14 days, 3 hours left

Utilization Review Specialist - Clinical Nursing Experience

About the Role:

The Utilization Review Specialist plays a crucial role in assessing the medical necessity and appropriateness of care for members. This position involves conducting authorization reviews, analyzing clinical information, and collaborating with key stakeholders to ensure the appropriate application of benefits.

Key Responsibilities:

  • Determine medical necessity and appropriateness by referencing regulatory mandates, contracts, benefit information, and medical guidelines.
  • Conduct research and analysis on diseases, treatments, and emerging technologies to support decision-making.
  • Collaborate with medical directors, sales, marketing, and provider services to determine appropriate benefit applications.
  • Make appropriate referrals and contacts as needed, assisting members and providers with alternative care settings.
  • Research and present educational topics related to cases, disease entities, and treatment modalities.

Pay Range:
$40 - $49 an hr. 

Education & Qualifications:

  • Bachelor’s Degree in Nursing (BSN) required.
  • 5 years of clinical nursing experience.
  • 2 years of care management experience.
  • In lieu of a Bachelor’s degree, an additional 4 years of relevant work experience is required.

Required Skills & Competencies:

  • Strong knowledge of managed care and health delivery systems.
  • Familiarity with clinical guidelines, medical policies, and accreditation standards.
  • Proficiency in IT and medical management systems.
  • Strong written and interpersonal communication skills.
  • Ability to quickly establish rapport with members through telephonic communication.
Job Requirement
  • Utilization Management
  • Nursing
  • Nurse
  • Clinical
  • Clinical Nursing
  • Utilization Review
  • medical
  • clinical informatio
  • regulatory
  • treatments
  • disease
  • care management
  • health
  • managed care
  • clinical guidelines
  • medical policies
Reach Out to a Recruiter
  • Recruiter
  • Email
  • Phone
  • Rohan Lazarus
  • rohan.lazarus@collabera.com
Apply Now
Apply Now
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Collabera is a leading global digital talent solutions firm. For over 25 years, we have provided digital and IT talent services, direct placement and career advisement, global remote talent and learning solutions to transform and diversify workforces for the Fortune 1000 globally.

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Collabera is a leading global digital talent solutions firm. For over 25 years, we have provided digital and IT talent services, direct placement and career advisement, global remote talent and learning solutions to transform and diversify workforces for the Fortune 1000 globally.

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