UM Regulatory Nurse Specialist, Health New England
Baystate Health(1 month ago)
About this role
The UM Regulatory Nurse Specialist at Health New England (Baystate Health) is a licensed RN who supports utilization management and health services compliance for the health plan. This full-time role is remote (eligible in MA and CT) and works to ensure operations meet accreditation, state and federal regulatory requirements. The position partners with Compliance, Legal, Quality and other stakeholders to support member care and program integrity.
Required Skills
- Utilization Management
- Clinical Review
- Care Coordination
- Preauthorization Review
- Concurrent Review
- Retrospective Review
- Discharge Planning
- Medical Coding
- Compliance Management
- Regulatory Filings
+3 more
Qualifications
- Bachelors Degree
- Registered Nurse - State of Massachusetts
- Certified Professional Coder (preferred)
About Baystate Health
baystatehealth.orgBaystate Health is a not-for-profit, academic healthcare system offering comprehensive medical services, health information, and community support.
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