Massachusetts Licensed Care Manager

Job Summary

A company is looking for a Utilization Management Care Manager.

Key Responsibilities

• Conduct clinical reviews for utilization management, including initial eligibility and coverage determinations
• Manage incoming requests for medical services and related clinical information
• Ensure adherence to performance metrics and maintain effective relationships with internal and external customers

Required Qualifications

• Associate's Degree in Nursing required; Bachelor's Degree preferred
• Massachusetts Registered Nurse License required
• 2-3 years of utilization review experience preferred
• Experience using Interqual or Milliman preferred
• 1-2 years of experience in a payer setting and acute care setting preferred