Massachusetts Licensed RN Utilization Reviewer

Job Summary

A company is looking for a Registered Nurse (RN) Utilization Reviewer in Massachusetts.

Key Responsibilities

• Process medical necessity reviews for healthcare service authorizations and assist with discharge planning activities
• Coordinate care and engage with collaborative partners to facilitate transitions to appropriate care levels
• Maintain knowledge of regulations and refer quality issues and members for care management as needed

Required Qualifications, Training, and Education

• Associate of Science (A.S) degree from an accredited registered nursing (RN) program required
• Three (3) years of clinical experience required
• Preferred experience in med/surgical, emergency acute care, or home health
• Current, unrestricted Registered Nurse (RN) licensure in the state of practice required
• MCG Certification or ability to obtain within six (6) months of hire required