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RN Utilization Management Reviewer at Blue Cross Blue Shield of Massachusetts - ApplyBlast

RN Utilization Management Reviewer

Blue Cross Blue Shield of Massachusetts

4 months ago

3.1 on Glassdoor

Hingham, MA

Onsite

Full Time

Senior

0 applicants

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About this role

The Clinical Utilization Reviewer facilitates care for members with complex healthcare needs by authorizing medically necessary services and managing care plans. This self-directed role involves conducting pre-certification, concurrent, and retrospective reviews to ensure efficient and appropriate benefit use. The position requires collaborating with various healthcare providers to develop cost-effective plans of care while adhering to clinical quality standards.

Responsibilities

Conduct pre-certification and concurrent reviews for member care
Evaluate clinical status to develop cost-effective care plans
Evaluate clinical status to develop care plans
Pass annual InterQual Interrater Reliability Test
Collaborate with providers to gather clinical information

Skills

Qualifications

Active RN Licensure in MassachusettsBachelor's Degree in Nursing (BSN)3-5 years Clinical Health Care ExperienceUtilization Management ExperienceHigh School Degree or Equivalent

About Blue Cross Blue Shield of Massachusetts

bluecrossma.org

Headquarters

Boston, Massachusetts, United States

Company Size

1001-5000 employees

Founded

1937

View Profile

Blue Cross Blue Shield of Massachusetts brings health insurance plans, medical claims, insurance coverage, benefits and telehealth via MyBlue Web & App