Massachusetts Licensed RN ReviewerVirtualVocations • Atlanta, Georgia, United States
Massachusetts Licensed RN Reviewer
VirtualVocations • Atlanta, Georgia, United States
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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
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