Massachusetts Licensed Prior Authorization RN

A company is looking for a Prior Authorization Clinician (Remote RN).

Key Responsibilities

Review and determine medical necessity for inpatient and outpatient services using evidence-based guidelines

Perform utilization review activities, including pre-certification and concurrent reviews, while documenting all outcomes

Provide guidance to other utilization review nurses and participate in team meetings and training sessions

Required Qualifications, Training, and Education

Active, unrestricted RN license in state of residence

Bachelor's degree preferred

2+ years of prior authorization experience with evidence-based guidelines

Knowledge of Medicare and Medicaid

Managed care experience