Massachusetts RN Utilization Management

A company is looking for an Inpatient Utilization Management Clinician.

Key Responsibilities :

Perform utilization review activities for inpatient cases, applying evidence-based criteria

Monitor inpatient cases for compliance with regulations and facilitate discharge planning

Document and communicate all utilization review activities and outcomes effectively

Required Qualifications, Training, and Education :

Active, unrestricted RN license in state of residence

Nursing degree or diploma required; bachelor's degree in nursing preferred

2+ years of utilization review experience and knowledge of evidence-based guidelines

Experience in managed care and discharge planning

Knowledge of Medicare and Medicaid is desirable