Massachusetts Licensed Prior Authorization Clinician

Job Summary

A company is looking for a Prior Authorization Clinician (Remote).

Key Responsibilities

• Conduct utilization reviews to assess medical necessity using evidence-based guidelines
• Evaluate inpatient and outpatient service requests for appropriate care delivery
• Document review determinations and collaborate with providers for case escalation

Required Qualifications

• Active, unrestricted RN license in state of residence
• 2+ years of prior authorization or utilization review experience
• Strong clinical judgment and critical thinking skills
• Experience in a managed care environment preferred
• Ability to work independently in a remote setting