Registered Nurse (RN) | Case ManagerLocation: Hanover, MDAgency: Cynet HealthPay: $2,110 per weekShift Information: Days - 5 days x 8 hoursContract Duration: 13 WeeksStart Date: 5/25/2026
Job Title: Utilization Review NurseProfession: Registered NurseSpecialty: Utilization ManagementDuration: 13 weeksShift: DayHours per Shift: 8:30 AM - 5:00 PMExperience:- Minimum 5 years of RN experience- Current experience in Utilization Review- Managed care experience preferredLicense:- Active RN LicenseCertifications:- BLS or MED-TEST not requiredMust-Have:- Proficiency in InterQual and/or Milliman criteria software systems- Recent experience with referral platforms such as Epic, NaviHealth, or AllScripts- Experience in a high production environmentDescription:The Utilization Review Nurse is responsible for managing health plan members in acute care and rehabilitative facilities.This position involves monitoring the appropriateness of care received by plan members in various settings.The Utilization Review Nurse applies member benefit and medical criteria to authorize services in coordination with medical directors.Proactively initiating discharge planning for members, including identifying post-discharge needs and coordinating referrals.Effective communication, both verbal and written, is necessary for authorizing or denying covered services with providers and members.The Utilization Review Nurse is a member of clinical and administrative teams in the area of assignment.Maintaining and updating clinical knowledge while ensuring adequate documentation and quality standards is required.This role requires excellent interpersonal skills to project a positive image of the Managed Care Program.Strong computer skills are needed to work with various applications and online systems.Ability to negotiate and resolve conflicts with external customers is essential.
Cynet Health is a TJC certified MBE and one of the fastest-growing healthcare staffing firms in the US providing Health Med and Health IT staffing and consulting services to countless hospitals, SNFs, clinics, labs, CROs, health & wellness centers, pharmacies, and other medical facilities across the United States. Headquartered in Sterling, Virginia, we are a certified Minority-Owned Business Enterprise and a recognized Diversity Supplier.