Massachusetts Licensed Utilization Review Coordinator

Job Summary

To support a growing healthcare team, the full-time Massachusetts Licensed Utilization Review Coordinator will perform clinical reviews to determine medical necessity and appropriate levels of care remotely, while collaborating with healthcare providers and managing case documentation.

Key responsibilities

• Gather and review clinical information to confirm medical necessity for procedures and services
• Conduct utilization management assessments and refer cases to Peer Reviewers when necessary
• Collaborate with healthcare providers to identify discharge needs and facilitate timely transitions to appropriate care levels

Required qualifications

• Minimum of three years of experience in an acute care clinical setting
• Active, current, and unrestricted professional licensure as an RN or LPN in Massachusetts or state of residency
• Proficient in Microsoft Office, including Word, Excel, Outlook, and PowerPoint