Massachusetts Licensed Utilization Review Nurse

Job Summary

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

Key Responsibilities

• Evaluate medical necessity, level of care, and length of stay for post-acute services
• Perform prior authorization, concurrent, and retrospective reviews using clinical criteria
• Collaborate with care teams and providers to support care planning and transitions of care

Required Qualifications

• Active, unrestricted Registered Nurse (RN) license; compact license preferred
• 3-5 years of clinical nursing experience required
• Prior experience within a managed care environment required
• Strong knowledge of post-acute care settings
• Familiarity with clinical review criteria and utilization management practices