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Clinical Utilization Review Specialist

2 months ago

Milford, Massachusetts, United States Milford Regional Medical Center Full time

About the Role:

Milford Regional Medical Center is seeking a skilled Clinical Utilization Review Specialist to join our team. As a key member of our healthcare team, you will be responsible for ensuring the medical appropriateness of inpatient and observation services.

Key Responsibilities:

  • Perform reviews of current inpatient services to determine medical appropriateness
  • Evaluate medical guidelines and benefit determination to make informed decisions
  • Manage the denial and appeal process under the guidance of the UR Manager
  • Collaborate with healthcare professionals to ensure high-quality patient care
  • Stay up-to-date with industry developments and best practices in utilization review

Requirements:

  • Bachelor of Science in Nursing required
  • Masters in Healthcare preferred
  • Massachusetts Registered Nurse licensure required
  • Certified Case Manager, preferred
  • Minimum of 5 years acute or critical care experience
  • Minimum of 1 year Nurse Case Management experience
  • Minimum of 1 year Utilization Review Nurse Experience including solid working knowledge with InterQual criteria

What We Offer:

  • A dynamic and supportive work environment
  • Opportunities for professional growth and development
  • A competitive salary and benefits package