Job Summary
A healthcare company is searching for a person to fill their position for a Remote Utilization Management RN in Boston.
Core Responsibilities Include:
- Determining medical appropriateness of inpatient and outpatient services
- Ensuring that members receive services in the most optimal setting to effectively meet their needs
- Telephonically provide and facilitate utilization review, continued stay reviews and utilization management of all cases
Skills and Requirements Include:
- Current, valid, and unrestricted MA state Registered Nurse (R.N.) license
- Around 2-3 years acute care clinical nursing experience in high-acuity settings
- At least 3 years of recent experience in Utilization Review / Utilization Management
- At least 3 years at a health plan or other Managed Care Organization (HMO/TPA/IPA/etc)
- Experience using MCG/Milliman/InterQual criteria for medical necessity, setting and level of care
