Massachusetts Licensed Inpatient UM Clinician

Job Summary

To support inpatient care reviews and medical necessity determinations, the fully remote Massachusetts Licensed Inpatient UM Clinician will manage care coordination activities for a diverse healthcare population while ensuring compliance with regulatory requirements.

Key responsibilities

• Conduct concurrent and retrospective reviews of inpatient admissions using clinical guidelines and evidence-based criteria
• Collaborate with multidisciplinary teams to support effective treatment planning and transitions of care
• Maintain thorough documentation of review activities, clinical determinations, and case outcomes

Required qualifications

• Active, unrestricted Registered Nurse (RN) license required, with preference for Massachusetts or New Hampshire licensure
• Minimum of 2 years of utilization management or inpatient case management experience
• Hands-on experience with InterQual or similar clinical review criteria
• Knowledge of inpatient authorization processes and healthcare regulations
• Bachelor of Science in Nursing (BSN) preferred; equivalent education and experience considered