Massachusetts RN Utilization Reviewer

Job Summary

A company is looking for a RN Utilization Management Reviewer.

Key Responsibilities:

• Conduct pre-certification, concurrent, and retrospective reviews focusing on utilization management and care coordination
• Evaluate clinical status and develop cost-effective, medically necessary plans of care
• Collaborate with a multidisciplinary team to ensure high-quality care coordination for members

Required Qualifications:

• 3-5 years of relevant experience in clinical healthcare settings
• 2-3 years of Utilization Management experience
• Active RN licensure in Massachusetts; additional state licensure is a plus
• Experience with IVF, maternity, reproductive, and gender-affirming health is preferred
• A bachelor's degree in nursing (BSN) is preferred for Registered Nurses