Utilization Review RN - Onsite, Impactful Care

Healthcare Support Staffing; Waltham (MA); On-site; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare recruiting firm in Waltham, Massachusetts, is seeking a Clinical Review Nurse. The role involves reviewing charts, promoting quality care through clinical acumen, and collaborating with healthcare staff. Candidates must have RN licensure and at least 3 years of utilization management experience in a managed care setting. This position is 100% office-based with a schedule of 8:00 AM to 5:00 PM. Interested candidates should apply or contact Ashley Greene for consideration.

Qualifications

• Must have RN licensure to apply.
• 3+ years of utilization management experience is required.
• Experience in clinical nursing for at least 2 years.

Responsibilities

• Review charts to ensure appropriate and cost-effective care.
• Promote quality by applying clinical acumen to reviews.
• Collaborate with staff to coordinate member care.
• Educate providers on management processes.
• Audit case reviews for compliance.
• Assist in developing workflows and policies.

Skills

Clinical judgment

Collaboration with healthcare staff

Education on medical management processes

Education

RN licensure

3+ years of UM experience in a managed care setting

2+ years of clinical nursing experience

Job description

A leading healthcare recruiting firm in Waltham, Massachusetts, is seeking a Clinical Review Nurse. The role involves reviewing charts, promoting quality care through clinical acumen, and collaborating with healthcare staff. Candidates must have RN licensure and at least 3 years of utilization management experience in a managed care setting. This position is 100% office-based with a schedule of 8:00 AM to 5:00 PM. Interested candidates should apply or contact Ashley Greene for consideration.