Massachusetts Licensed Clinical Reviewer RN

Job Summary

A company is looking for a Clinical Reviewer, Inpatient RN.

Key Responsibilities

• Provide utilization management activities for members in inpatient settings
• Determine medical necessity and reimbursement methodology for inpatient admissions and continued stays
• Perform discharge planning and identify complex members for case management referrals

Required Qualifications

• Current, unrestricted Massachusetts RN license
• Associate degree required; BSN preferred
• Minimum of 3 years of clinical nursing experience
• Minimum of 3 years of Utilization Management experience
• Ability to apply Evidence Based Criteria and/or Medical Necessity Guidelines