Massachusetts Licensed Utilization Nurse

Job Summary

A company is looking for a Utilization Management Nurse.

Key Responsibilities

• Collaborate with staff and payers to manage admissions, days of stay, and reimbursement
• Coordinate appeals for clinical denials and communicate with relevant parties to ensure payment
• Assist in various functions of the care coordination department to comply with mandates and improve outcomes

Required Qualifications

• Bachelor's Degree in Nursing required
• Massachusetts Registered Nurse license
• Previous experience in a hospital or healthcare setting required
• Five years of medical or surgical staff nurse experience required
• Experience with utilization review and medical criteria sets required