Massachusetts Licensed Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse.

Key Responsibilities

• Conduct clinical reviews for utilization management, including eligibility and coverage determinations
• Manage incoming requests for medical services and patient medical records
• Ensure adherence to departmental performance metrics and maintain effective relationships with internal and external customers

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 in a payer setting and an acute care setting preferred
• Experience using Interqual or Milliman preferred