Remote Utilization Management Nurse - Clinical Review

Mass General Brigham; United States; Teletrabalho; USD 90 000 - 107 000; Tempo integral

Resumo da oferta

Mass General Brigham is seeking an RN for a remote Utilization Management role in the United States. The position involves clinical review, triage, and escalation support to ensure medical necessity and regulatory compliance.

The role requires 2–3 years in case management or utilization review, Massachusetts RN licensure, and BLS certification preferred. Occasional onsite meetings in Somerville, MA may occur, with a 40-hour work week.

Qualificações

• At least 2–3 years of case management, utilization review, or discharge planning experience preferred.
• Massachusetts Registered Nurse (RN) license; BLS certification preferred.

Responsabilidades

• Serves as the primary point of contact for escalated utilization management inquiries.
• Reviews and responds to escalated authorization and coverage issues with Nurse Reviewers, Medical Directors, and teams.
• Monitors escalation channels and prioritizes requests by clinical urgency, regulatory requirements, and business impact.
• Provides consultation on benefit interpretation, medical necessity criteria, and workflow processes.
• Identifies trends and opportunities to improve efficiency and member outcomes through escalation reviews.

Conhecimentos

Case management

Utilization review

Discharge planning

Formação académica

Associate’s Degree in Nursing

Bachelor’s Degree in Nursing

Massachusetts RN license

BLS Certification

Descrição da oferta de emprego

Mass General Brigham is seeking an RN for a remote Utilization Management role in the United States. The position involves clinical review, triage, and escalation support to ensure medical necessity and regulatory compliance.

The role requires 2–3 years in case management or utilization review, Massachusetts RN licensure, and BLS certification preferred. Occasional onsite meetings in Somerville, MA may occur, with a 40-hour work week.