Massachusetts Licensed UM Nurse Specialist

Job Summary

A company is looking for a UM Regulatory Nurse Specialist.

Key Responsibilities

• Conduct pre-authorization, admission, concurrent, and retrospective reviews to assess the appropriateness of services and care levels
• Assist with care coordination, referral management, and proactive discharge planning for members
• Develop and coordinate compliance education and training activities, and manage compliance regulatory filings and audits

Required Qualifications

• Massachusetts RN license required
• 3-5 years' experience as a UM Clinical Review Nurse for a Health Plan
• Understanding of the use of medical coding
• Strong critical thinking and analytical skills
• Innovative thinker with strong research skills