Massachusetts Licensed Utilization Clinician

Job Summary

A company is looking for an Inpatient Utilization Management Clinician.

Key Responsibilities

• Conduct concurrent and retrospective inpatient utilization reviews to determine medical necessity and appropriate levels of care
• Gather and analyze clinical documentation from electronic medical records to support review determinations and authorizations
• Collaborate with healthcare professionals to support effective care progression and appropriate discharge planning

Required Qualifications

• Active, unrestricted Registered Nurse (RN) license in the state of residence
• Minimum of two years of utilization review experience using evidence-based clinical guidelines
• Experience in managed care, inpatient review processes, and discharge planning coordination
• Strong clinical judgment and analytical thinking skills
• Ability to manage complex cases while meeting regulatory timelines