Remote Utilization Management Nurse — Post-Acute Care

Mass General Brigham Health Plan; Somerville (MA); Hybrid; USD 90,000 - 107,000; Full time

Job summary

Mass General Brigham Health Plan is seeking a Utilization Management Nurse for post-acute care settings to analyze, authorize, and determine medical necessity for SNF, LTAC, and rehab services. The UM Clinical Manager will review cases following InterQual criteria with physician oversight where needed.

The ideal candidate has 2–3 years in utilization review, MA RN licensure, and payer or managed care experience.

Qualifications

• Nursing degree required or preferred.
• Massachusetts RN license required.
• 2–3 years in post-acute utilization review preferred.
• Experience with InterQual or Milliman preferred.
• 1–2 years in payer setting preferred.
• 1–2 years in acute care setting preferred.

Responsibilities

• Ensures post-acute services are clinically appropriate and aligned with best practices.
• Guides decisions on admission, continued stay, transfer readiness, or discharge.
• First-level screening with physician oversight when criteria are not met.
• Accounts for patient severity and comorbidities.
• Includes endpoints for recovery, plateau, or goal achievement for care planning.
• Proficient with Microsoft Word, Excel, Outlook, SharePoint, and related tools.

Skills

Utilization review

Post-acute care

InterQual

Milliman

Microsoft Office

Communication skills

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Tools

InterQual

Milliman

Job description

Mass General Brigham Health Plan is seeking a Utilization Management Nurse for post-acute care settings to analyze, authorize, and determine medical necessity for SNF, LTAC, and rehab services. The UM Clinical Manager will review cases following InterQual criteria with physician oversight where needed.

The ideal candidate has 2–3 years in utilization review, MA RN licensure, and payer or managed care experience.