Massachusetts Licensed Utilization Review Manager

Job Summary

To support patient care transitions, the part-time Massachusetts Licensed Utilization Review Manager will perform utilization reviews, coordinate care with various stakeholders, and manage audits and appeals in a remote setting.

Key responsibilities

• Conduct utilization reviews to assess the appropriate level of care and ensure timely communication with insurers
• Collaborate with healthcare teams and payers to manage admissions, continued care, and reimbursement processes
• Monitor quality issues and document findings while serving as a resource for staff regarding insurance denials

Required qualifications

• Bachelor's Degree in Nursing required
• Massachusetts Registered Nurse License required
• 5 years of Acute Care Nursing experience required
• 3-4 years of Utilization Review and Case Management experience preferred
• Competency in InterQual Criteria and utilization review processes