Massachusetts RN Utilization Management

A company is looking for an Inpatient Utilization Management Clinician. Key Responsibilities: Conducts utilization review activities for inpatient cases using evidence-based criteria Collaborates with care management and medical directors to facilitate discharge planning and ensure compliance with guidelines Monitors inpatient cases for regulatory compliance and provides guidance to other utilization review nurses Required Qualifications, Training, and Education: Active, unrestricted RN license in the state of residence Nursing degree or diploma required; bachelor's degree in nursing preferred 2+ years of utilization review experience with evidence-based guidelines Managed care experience and familiarity with Medicare and Medicaid Ability to take after-hours calls, including evenings and weekends

Mar 11, 2025 - 09:49

A company is looking for an Inpatient Utilization Management Clinician. Key Responsibilities: Conducts utilization review activities for inpatient cases using evidence-based criteria Collaborates with care management and medical directors to facilitate discharge planning and ensure compliance with guidelines Monitors inpatient cases for regulatory compliance and provides guidance to other utilization review nurses Required Qualifications, Training, and Education: Active, unrestricted RN license in the state of residence Nursing degree or diploma required; bachelor's degree in nursing preferred 2+ years of utilization review experience with evidence-based guidelines Managed care experience and familiarity with Medicare and Medicaid Ability to take after-hours calls, including evenings and weekends