Massachusetts RN Clinical Care Reviewer
Job Summary
Responsible for processing medical necessity reviews and coordinating care, the full-time Massachusetts RN Clinical Care Reviewer will work remotely to ensure the appropriateness of healthcare service authorizations and assist with discharge planning activities.
Key responsibilities:
- Complete prospective, concurrent, and retrospective reviews for various healthcare services
- Coordinate care by engaging with collaborative partners and ensuring smooth transitions for members
- Maintain knowledge of regulations and identify quality issues for referral to Quality Improvement
Required qualifications:
- Current, unrestricted Registered Nurse (RN) Licensure in Massachusetts
- Associate of Science (A.S) from an accredited registered nursing program
- Three years of clinical experience required
- Preferred experience in med/surgical, emergency acute clinical care, or home health
- Utilization Management/Utilization Review experience preferred
Complete Job Description
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