RN Utilization Management Specialist
massgeneralbrigham
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Job summary
Mass General Brigham Health Plan is seeking an experienced RN to support outpatient utilization management decisions, using InterQual criteria within a managed care setting. Massachusetts RN license required; on-call availability at least once per month; strong communication and record-management skills; competitive base pay between $90,000 and $107,000 with comprehensive benefits.
Join a not-for-profit leader committed to patient care, research and community service, with opportunities for
Qualifications
- RN license in Massachusetts required.
- Associate's Degree in Nursing or Bachelor’s Degree in Nursing preferred.
- Experience in utilization management or prior authorization in a managed care setting is a plus.
- Strong communication and documentation skills.
Responsibilities
- Perform clinical reviews for prospective, concurrent, and retrospective utilization management.
- Review authorization requests for medical services and determine medical necessity.
- Gather patient records and ensure accurate documentation.
- Maintain knowledge of commercial, self-insured, and fully insured plans.
- Collaborate with internal/external stakeholders and meet performance metrics.
- Availability for on-call shifts with monthly frequency.
- Balance multiple tasks while building strong professional relationships.
Skills
Education
Tools
Job description
Mass General Brigham Health Plan is seeking an experienced RN to support outpatient utilization management decisions, using InterQual criteria within a managed care setting. Massachusetts RN license required; on-call availability at least once per month; strong communication and record-management skills; competitive base pay between $90,000 and $107,000 with comprehensive benefits.
Join a not-for-profit leader committed to patient care, research and community service, with opportunities for
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