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 an inpatient setting
• Determine medical necessity and reimbursement methodology for inpatient admissions and continued stays
• Develop collaborative relationships with providers to facilitate member transitions through their continuum of care

Required Qualifications

• Registered nurse with 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 clinical criteria and mentor staff