LTSS Utilization Management RN - Hybrid Clinical Liaison

cityblockhealth; United States; Hybrid; USD 95,000 - 125,000; Full time

Job summary

Cityblock Health is seeking a Lead LTSS Nurse Liaison in Massachusetts. The role entails synthesizing assessments, producing clinical determinations, and coordinating with Utilization Management to support long-term services and supports.

The position blends remote and in-person work and requires strong documentation and regulatory compliance. The role also manages an appeals queue, ensures decisions are well-supported, and collaborates with market care teams and external agencies to safeguard

Qualifications

• Active, unrestricted Massachusetts RN license at time of hire.
• Experience with LTSS and plan review is a plus.

Responsibilities

• Perform clinical reviews and functional assessments against level-of-care criteria.
• Develop clinical determinations and rationales for initial requests and redeterminations.
• Submit determinations to Utilization Management and coordinate clinical exchanges.
• Manage an appeals queue and prepare materials for hearings.
• Maintain daily queue management and prioritize by deadlines.
• Collaborate with market care teams, external LTSS service agencies, and health plan staff.
• Ensure audit-ready documentation and ICD/CPT coding compliance.
• Adapt to regulatory changes and translate them into practice.

Skills

Clinical judgment

Regulatory compliance

Documentation

Education

Massachusetts RN license

Job description

Cityblock Health is seeking a Lead LTSS Nurse Liaison in Massachusetts. The role entails synthesizing assessments, producing clinical determinations, and coordinating with Utilization Management to support long-term services and supports.

The position blends remote and in-person work and requires strong documentation and regulatory compliance. The role also manages an appeals queue, ensures decisions are well-supported, and collaborates with market care teams and external agencies to safeguard