Providing clinical review and escalation support, the full-time Massachusetts Licensed Utilization Nurse will manage inquiries, assess medical necessity, and collaborate with interdisciplinary teams in a remote setting. Key responsibilities Serve as the primary point of contact for escalated utilization management inquiries, ensuring timely triage and resolution Review and respond to escalated authorization and coverage determination issues, coordinating with Nurse Reviewers and Medical Directors Monitor escalation channels and prioritize requests based on clinical urgency and regulatory requirements Required qualifications Associate's Degree in Nursing required; Bachelor's Degree in Nursing preferred Massachusetts Registered Nurse (RN) license At least 2-3 years of case management, utilization review, or discharge planning experience preferred Basic Life Support (BLS) Certification preferred Knowledge of healthcare and managed care preferred