Massachusetts Licensed Review Nurse

Job Summary

A company is looking for a UM Outpatient Clinical Review Nurse.

Key Responsibilities

• Perform clinical reviews for outpatient care to assess health and medical necessity
• Document review findings and maintain member medical records in health management systems
• Collaborate with healthcare providers and Medical Directors on care approvals and recommendations

Required Qualifications, Training, and Education

• Current MA RN License required
• Bachelor's degree preferred with 3-5 years of nursing experience
• Knowledge of utilization management, Medicare, and Medicaid strongly preferred
• Prior nursing experience in ICU or ER is beneficial
• Computer literacy and ability to navigate through health management systems