Remote RN: Utilization Management & Review

Mass General Brigham Health Plan Holding Company, Inc.; Somerville (MA); Remote; USD 59,000 - 142,000; Full time

Job summary

Mass General Brigham Health Plan Holding Company, Inc. is seeking an experienced nurse for utilization review in a remote-friendly setting with occasional onsite work in Somerville, MA.

The role emphasizes clinical knowledge, medical necessity determinations, and collaboration with diverse health plan teams to optimize patient care. The ideal candidate has 2–3 years of utilization review experience, familiarity with InterQual/Milliman, and strong communication skills.

Qualifications

• Nursing degree required or preferred.
• Massachusetts RN license required.
• 2–3 years utilization review experience preferred.
• Experience with InterQual or Milliman preferred.
• Payer and acute care experience desired.

Responsibilities

• Lead clinical reviews for utilization management across lines of business.
• Review authorization requests and determine medical necessity.
• Manage incoming requests and related medical records.
• Maintain relationships with internal and external customers.
• Operate under performance metrics and ensure productivity.

Skills

Communication skills

Problem solving

Time management

Self-motivation

Team collaboration

Technology aptitude

Education

Bachelor’s or Associate degree in Nursing

Tools

InterQual

McKesson InterQual

MS Word/Excel/Outlook

SharePoint

Job description

Mass General Brigham Health Plan Holding Company, Inc. is seeking an experienced nurse for utilization review in a remote-friendly setting with occasional onsite work in Somerville, MA.

The role emphasizes clinical knowledge, medical necessity determinations, and collaboration with diverse health plan teams to optimize patient care. The ideal candidate has 2–3 years of utilization review experience, familiarity with InterQual/Milliman, and strong communication skills.