Massachusetts Licensed Utilization Nurse

Job Summary

Providing clinical review and escalation support, the full-time Massachusetts Licensed Utilization Nurse will manage inquiries, assess medical necessity, and collaborate with interdisciplinary teams in a remote setting.

Key responsibilities

• Serve as the primary point of contact for escalated utilization management inquiries, ensuring timely triage and resolution
• Review and respond to escalated authorization and coverage determination issues, coordinating with Nurse Reviewers and Medical Directors
• Monitor escalation channels and prioritize requests based on clinical urgency and regulatory requirements

Required qualifications

• Associate's Degree in Nursing required; Bachelor's Degree in Nursing preferred
• Massachusetts Registered Nurse (RN) license
• At least 2-3 years of case management, utilization review, or discharge planning experience preferred
• Basic Life Support (BLS) Certification preferred
• Knowledge of healthcare and managed care preferred