RN Utilization Management Reviewer
Blue Cross Blue Shield of Massachusetts(4 months ago)
About this role
The RN Utilization Management Reviewer is a licensed registered nurse who facilitates care for members with complex needs by authorizing medically necessary services and aligning care with benefit coverage. The role applies managed care principles, medical necessity criteria, and company policies to promote optimal health outcomes. The position works independently and as part of a multidisciplinary clinical team.
Required Skills
- Utilization Management
- Care Coordination
- Clinical Assessment
- Documentation
- InterQual
- Communication
- IT Systems
- Discharge Planning
- Quality Monitoring
- Medical Necessity
Qualifications
- Active RN Licensure (MA)
- BSN Preferred
- High School Diploma or Equivalent
About Blue Cross Blue Shield of Massachusetts
bluecrossma.orgBlue Cross Blue Shield of Massachusetts brings health insurance plans, medical claims, insurance coverage, benefits and telehealth via MyBlue Web & App
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