Inpatient RN — Clinical Utilization Reviewer

Us Tech Solutions; Canton (MA); On-site; USD 55,000 - 83,000; Full time

Job summary

US Tech Solutions is seeking a Clinical Reviewer, Inpatient RN for a 4-month contract to manage a clinically complex caseload across inpatient settings, including acute, subacute, and LTAC. You will determine medical necessity and coverage for Medicare and other plans, working independently and with the team.

The role emphasizes sound clinical judgment, utilization management criteria (InterQual/MCG), discharge planning, and collaboration with providers.

Qualifications

• Active, unrestricted Massachusetts RN license.
• BSN preferred.
• Three years of clinical nursing experience.
• Minimum 3 years of UM experience, inpatient preferred.
• Experience using utilization management criteria.
• Ability to document using computer systems per standards.

Responsibilities

• Manage a clinically complex caseload across inpatient settings.
• Determine medical necessity and plan benefit coverage.
• Perform utilization management and discharge planning.
• Collaborate with providers to facilitate transitions of care.
• Float to cover unassigned facilities as needed.
• Apply clinical criteria sets and guidelines in decisions.

Skills

Interpersonal skills

Communication

Negotiation

Time management

Independent work

Flexibility

Tech proficiency

Documentation

Self-directed

Education

Registered Nurse with MA license

BSN: Preferred

Tools

Microsoft Word

Excel

Job description

US Tech Solutions is seeking a Clinical Reviewer, Inpatient RN for a 4-month contract to manage a clinically complex caseload across inpatient settings, including acute, subacute, and LTAC. You will determine medical necessity and coverage for Medicare and other plans, working independently and with the team.

The role emphasizes sound clinical judgment, utilization management criteria (InterQual/MCG), discharge planning, and collaboration with providers.