Massachusetts Licensed Utilization Clinician

Job Summary

A company is looking for an Inpatient Utilization Management Clinician to evaluate inpatient medical treatments and facilitate discharge planning.

Key Responsibilities:

• Conducts utilization review activities for inpatient cases using evidence-based guidelines
• Monitors inpatient cases for compliance with contractual obligations and regulatory requirements
• Collaborates with care management and medical directors to support optimal health outcomes for members

Required Qualifications and Education:

• Active, unrestricted RN license in state of residence
• Nursing degree or diploma required; bachelor's degree in nursing preferred
• 2+ years of utilization review experience and familiarity with evidence-based guidelines
• Managed care experience and experience in discharge planning
• Knowledge of Medicare and Medicaid preferred