Massachusetts Licensed RN Reviewer

Job Summary

A company is looking for an RN Utilization Management Reviewer.

Key Responsibilities:

• Conduct pre-certification, concurrent, and retrospective reviews focusing on utilization management and care coordination
• Evaluate members' clinical status and develop cost-effective, medically necessary plans of care
• Collaborate with a team of professionals to provide high-level care coordination and monitor clinical quality concerns

Required Qualifications:

• 3-5 years of relevant experience in clinical health care settings
• Utilization Management experience preferred
• Active licensure in Massachusetts is required
• Bachelor's degree in nursing (BSN) preferred for registered nurses
• Ability to interpret and document complex medical information