Massachusetts Licensed Utilization Clinician

A company is looking for an Inpatient Utilization Management Clinician. Key Responsibilities Conduct concurrent and retrospective inpatient utilization reviews to determine medical necessity and appropriate levels of care Gather and analyze clinical documentation from electronic medical records to support review determinations and authorizations Collaborate with healthcare professionals to support effective care progression and appropriate discharge planning Required Qualifications Active, unrestricted Registered Nurse (RN) license in the state of residence Minimum of two years of utilization review experience using evidence-based clinical guidelines Experience in managed care, inpatient review processes, and discharge planning coordination Strong clinical judgment and analytical thinking skills Ability to manage complex cases while meeting regulatory timelines