Massachusetts Licensed Inpatient UM Clinician

Job Summary

To support medical necessity reviews and care coordination, the fully remote Massachusetts Licensed Inpatient UM Clinician will evaluate inpatient admissions, collaborate with healthcare teams, and ensure compliance with clinical documentation standards.

Key responsibilities

• Evaluate inpatient admissions and continued stays to determine medical necessity and appropriate levels of care
• Collaborate with physicians and care teams to support timely care decisions and effective discharge planning
• Review clinical documentation to ensure compliance with regulatory, contractual, and quality standards

Required qualifications

• Active, unrestricted Registered Nurse (RN) license; Massachusetts, New Hampshire, or Compact RN licensure preferred
• Minimum of 2 years of utilization management, utilization review, or related managed care experience
• Experience applying InterQual or other evidence-based clinical review criteria
• Strong clinical judgment and critical thinking skills in complex healthcare environments
• Proficiency in remote work settings and healthcare technology platforms