Massachusetts Licensed Utilization Specialist

Job Summary

A company is looking for a Utilization Management Specialist.

Key Responsibilities

• Reviews patient admissions to ensure compliance with authorization and payer requirements
• Collaborates with medical staff and payers to address level of care issues and manage denials
• Documents clinical information and updates related to patient care and billing processes

Required Qualifications

• Completion of an accredited nursing program
• Current Massachusetts RN licensure and registration
• Two years of experience in utilization review, case management, or relevant clinical experience
• Knowledge of utilization review practices and principles
• Ability to work independently and use specialized computer systems for data analysis