Clinical Care Reviewer II - Massachusetts
CareSource(1 month ago)
About this role
Clinical Care Reviewer II is a clinical role within a payer organization focused on evaluating clinical requests and supporting utilization management decisions for members. The position operates within clinical and regulatory frameworks to ensure appropriate authorization, continuity of care, and adherence to quality standards. It interfaces with clinical teams, providers, and organizational stakeholders to support compliant, member-centered care delivery.
Required Skills
- Care Coordination
- Discharge Planning
- Utilization Review
- Clinical Documentation
- Data Entry
- Communication
- Time Management
- Decision Making
Qualifications
- Associate of Science (AS) in Nursing
- Registered Nurse (RN) Licensure
- MCG Certification
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