Massachusetts Licensed RN Reviewer

A company is looking for an RN Utilization Management Reviewer.

Key Responsibilities :

Conduct pre-certification, concurrent, and retrospective reviews focusing on utilization management and care coordination

Evaluate members' clinical status and develop cost-effective, medically necessary plans of care

Monitor clinical quality concerns and interact with various healthcare providers to gather necessary clinical information

Key Qualifications :

3-5 years of relevant experience in clinical healthcare settings

Utilization Management experience preferred

Active RN licensure in Massachusetts; additional state licensure is a plus

Proficient with multiple IT systems

Bachelor's degree in nursing (BSN) preferred for Registered Nurses