Massachusetts Licensed Utilization Nurse

Job Summary

To support a growing healthcare team, the full-time remote Massachusetts Licensed Utilization Nurse will utilize clinical knowledge to analyze and approve medical service requests, manage incoming authorization requests, and ensure adherence to performance metrics.

Key responsibilities:

• Conduct clinical reviews for utilization management using Interqual and company policies
• Review authorization requests for medical services, determining eligibility and medical necessity
• Manage incoming requests for procedures and services, including patient medical records

Required qualifications:

• Associate's Degree in Nursing required; Bachelor's Degree preferred
• Massachusetts Registered Nurse (RN) license required
• 2-3 years of utilization review experience preferred
• Experience with Interqual or Milliman preferred
• 1-2 years of experience in a payer setting preferred