Telecommute Utilization Review RN in Boston

Job is Expired
Location: Massachusetts
Compensation: To Be Discussed
Staff Reviewed: Thu, Jan 20, 2022
Job Summary

A healthcare staffing and recruiting firm is in need of a Telecommute Utilization Review RN in Boston.

Must be able to:

  • Perform utilization management and utilization review for prospective (prior authorization), concurrent, or retrospective review
  • Perform reviews of services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination
  • Utilize clinical skills to telephonically provide and facilitate utilization review, continued stay reviews and utilization management of all cases based on clinical experience and recognized guidelines

Qualifications Include:

  • Current, valid, and unrestricted state Registered Nurse (R.N.) license
  • Around 2-3 years acute care clinical nursing experience, to include working in high-acuity settings such as Med/Surg, ICU, Step-Down, ED/ER; or
  • At least 3 years of recent experience in Utilization Review / Utilization Management, additional years of Case Management
  • At least 1-2 years at a health plan or other Managed Care Organization (HMO/TPA/IPA/etc)
  • Experience using InterQual criteria for medical necessity, setting and level of care, and concurrent patient management
  • Ability to identify ongoing clinical care needs and ensure that members receive services in the most optimal setting to effectively meet their needs
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