Massachusetts Licensed RN Reviewer

A company is looking for an RN Utilization Management Reviewer.

Key Responsibilities :

Conduct pre-certification, concurrent, and retrospective reviews focusing on utilization management and care coordination

Evaluate members' clinical status and develop cost-effective, medically necessary plans of care

Collaborate with a team of professionals to provide high-level care coordination and monitor clinical quality concerns

Required Qualifications :

3-5 years of relevant experience in clinical health care settings

Utilization Management experience preferred

Active licensure in Massachusetts is required

Bachelor's degree in nursing (BSN) preferred for registered nurses

Ability to interpret and document complex medical information