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UM Nurse (Contract) MA License required

The Jacobson Group Worcester Contractor
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Job Description:

Our health plan client is seeking a Utilization Management Nurse to support their growing membership. This opportunity is a remote position but will require two days of travel to Massachusetts for training. Jacobson will cover travel expenses including hotel, airfare, rental car and a $40 per diem.

Responsibilities:

  • Organize, coordinate, monitor, evaluate and modify plans of care or service requests, focusing on select complex medical and psychosocial needs of members.
  • Work with Medical Directors, Authorization Coordinators, and Service Coordinators to perform first-level reviews to pre-certify elective services, procedures and tests, utilizing established care coordination policies and protocols, client criteria, regulatory review criteria, and nationally accepted criteria for medical necessity determination.

Requirements:

  • Active RN license in Massachusetts
  • 2 years of utilization management experience in a payer setting
  • 1 year as a case manager in a payer setting (preferred)
  • Discharge planning background (preferred)
 

Recommended skills

Authorization (Medical)
Authorization (Computing)
Operating Expense
Utilization Management
Testing
Psychosocial
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Job ID: BHJOB1899_20101

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