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Massachusetts RN Utilization Reviewer
A company is looking for a RN Clinical Utilization Management Reviewer. Key Responsibilities: Conducts timely clinical decision review for services requiring prior authorization Applies established criteria to determine medical necessity of services Communicates results of reviews and provides decision-making guidance to clinical teams Required Qualifications: Associates Degree required; Bachelor's Degree preferred Current Massachusetts RN clinical license in good standing 3+ years of combined clinical and utilization management experience required Experience with a health plan and/or care management platform is a strong plus Experience with Epic and InterQual preferred
A company is looking for a RN Clinical Utilization Management Reviewer.
Key Responsibilities:
Conducts timely clinical decision review for services requiring prior authorization
Applies established criteria to determine medical necessity of services
Communicates results of reviews and provides decision-making guidance to clinical teams
Required Qualifications:
Associates Degree required; Bachelor's Degree preferred
Current Massachusetts RN clinical license in good standing
3+ years of combined clinical and utilization management experience required
Experience with a health plan and/or care management platform is a strong plus
Experience with Epic and InterQual preferred
