Massachusetts Licensed Clinical Care Reviewer
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Job Summary
To support healthcare service authorization, the full-time Massachusetts Licensed Clinical Care Reviewer will process medical necessity reviews, assist with discharge planning, and coordinate care for members in a remote setting.
Key responsibilities:
- Complete prospective, concurrent, and retrospective reviews for various healthcare services
- Engage with care partners to facilitate transitions to appropriate levels of care
- Maintain knowledge of regulations and refer quality issues to Quality Improvement
Required qualifications:
- Current, unrestricted Registered Nurse (RN) Licensure in Massachusetts
- Completion of an accredited registered nursing (RN) degree program
- Three (3) years of clinical experience required
- Utilization Management/Utilization Review experience preferred
- Med/surgical, emergency acute clinical care, or home health experience preferred
Complete Job Description
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