Massachusetts RN Utilization Reviewer

Job Summary

A company is looking for a RN Clinical Utilization Management Reviewer.

Key Responsibilities:

• Conducts timely clinical decision review for services requiring prior authorization
• Applies established criteria to determine medical necessity of services
• Communicates results of reviews and provides decision-making guidance to clinical teams

Required Qualifications:

• Associates Degree required; Bachelor's Degree preferred
• Current Massachusetts RN clinical license in good standing
• 3+ years of combined clinical and utilization management experience required
• Experience with a health plan and/or care management platform is a strong plus
• Experience with Epic and InterQual preferred