Massachusetts Licensed Utilization Nurse

To support a growing healthcare team, the full-time remote Massachusetts Licensed Utilization Nurse will utilize clinical knowledge to analyze and approve medical service requests, manage incoming authorization requests, and ensure adherence to performance metrics. Key responsibilities: Conduct clinical reviews for utilization management using Interqual and company policies Review authorization requests for medical services, determining eligibility and medical necessity Manage incoming requests for procedures and services, including patient medical records Required qualifications: Associate's Degree in Nursing required; Bachelor's Degree preferred Massachusetts Registered Nurse (RN) license required 2-3 years of utilization review experience preferred Experience with Interqual or Milliman preferred 1-2 years of experience in a payer setting preferred