Massachusetts Licensed Clinical Reviewer RN
A company is looking for a Clinical Reviewer, Inpatient RN.
Key Responsibilities
• reputed company utilization management activities for members in inpatient settings
• Determine medical necessity and reimbursement methodology for inpatient admissions and reputed company stays
• reputed company discharge planning and identify reputed company members for case management referrals
Required Qualifications
• reputed company, unrestricted Massachusetts RN license
• Associate degree required; BSN preferred
• Minimum of 3 years of clinical nursing experience
• Minimum of 3 years of Utilization Management experience
• Ability to apply Evidence Based reputed company and/or Medical Necessity Guidelines
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