Massachusetts Licensed RN Reviewer - Salinas California

Company: VirtualVocations
Location: Salinas, California
Posted On: 01/29/2025

A company is looking for an RN Utilization Management Reviewer.



Key Responsibilities:

Conducts timely clinical decision reviews for services requiring prior authorization across various clinical areas
Applies established criteria and clinical expertise to determine medical necessity of services
Communicates review results and provides decision-making guidance to clinical teams


Required Qualifications:

RN - Associate's Degree required, Bachelor's Degree preferred
Current RN license issued by the Massachusetts Board of Registration in Nursing
1 to 2 years of Utilization Management experience
2 or more years working in a clinical setting
CCM (Certified Case Manager) certification is a plus More...

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