Massachusetts Licensed Clinical Reviewer RN
Job Summary
Managing a clinically complex caseload, the full-time Massachusetts Licensed Clinical Reviewer RN will perform utilization management activities for inpatient settings, determining medical necessity and facilitating discharge planning while working remotely.
Key responsibilities
- Provide utilization management activities for members in an inpatient setting, including initial and concurrent reviews
- Determine reimbursement methodologies and conduct reviews for inpatient admissions and continued stays
- Identify complex members and refer them to appropriate case management or disease management programs
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
- Experience with evidence-based clinical criteria sets, such as InterQual or MNGs
Complete Job Description
The complete job description is available to members. Premium membership includes:
Full access to 40,565 remote jobs from human-vetted companies, updated daily
Resume Builder - AI-powered tool to craft, enhance, and tailor your resume to a specific job
Twice-monthly live group coaching and the full Remote Career Center
20% member discount on Career Services
Backed by a 30-day money-back guarantee
Company Company Name
Headquarters Headquarters
Founded Founded
Website
The company description is available to members. Go Premium for full access to every job and company profile in our remote jobs database, backed by a 30-day money-back guarantee.
