Utilization Management Specialist - RN (Remote)

**Resp & Qualifications**

**PURPOSE:**
This clinical position will support our Government Program lines of business. Utilizing key principles of utilization management, the Utilization Review Specialist (RN) will perform prospective, concurrent and retrospective reviews for authorization, appropriateness of care determination and benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts, mandates, medical policy, evidence based published research, national accreditation and regulatory requirements contribute to determination of appropriateness and authorization of clinical services both medical and behavioral health. The ideal candidate will have a working knowledge of managed care and health delivery systems, and previous experience with Medicaid and DSNP populations.

We are looking for an experienced clinician to work remotely from within the greater Baltimore/Wash...