Massachusetts Licensed Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse - Post-Acute Care.

Key Responsibilities

• Conduct clinical reviews for post-acute services to determine medical necessity and appropriate level of care
• Evaluate clinical documentation to support authorization decisions and length of stay determinations
• Communicate determinations to providers and collaborate with case managers and interdisciplinary teams

Required Qualifications

• Active, unrestricted Registered Nurse (RN) license required
• Bachelor of Science in Nursing (BSN) preferred
• 3-5 years of clinical nursing experience required
• Prior experience within a managed care or health plan environment required
• Familiarity with utilization review criteria and understanding of levels of care guidelines