Massachusetts Licensed Clinical Care Reviewer

Job Summary

A company is looking for a Clinical Care Reviewer II in Massachusetts.

Key Responsibilities

• Process medical necessity reviews for healthcare services and assist with discharge planning activities
• Coordinate care and engage with collaborative partners to facilitate transitions to appropriate care levels
• Monitor healthcare service delivery and identify quality issues for referral to Quality Improvement

Required Qualifications, Training, and Education

• Associate of Science (A.S) or completion of an accredited registered nursing (RN) degree program required
• Three (3) years of clinical experience required
• Med/surgical, emergency acute clinical care, or home health experience preferred
• Utilization Management/Utilization Review experience preferred
• Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice required