Utilization Review Nurse Job at Hub Technology Group, Boston, MA

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  • Hub Technology Group
  • Boston, MA

Job Description

Nurse Reviewer -Utilization Management / Prior Authorization

3-6+ Month Contract / Temp to Perm

Compact License Required

  • Determine medical appropriateness of services following evaluation of medical guidelines applying evidenced-based InterQual® criteria, Medical Policy and benefit determination.
  • Perform utilization review activities, including pre-certification, concurrent and retrospective reviews according to guidelines.
  • Determine medical necessity of each request by utilizing approved evidenced based guidelines / criteria
  • Utilize decision-making and critical-thinking skills in the review and determination of coverage
  • Reviews, documents, and communicates all utilization review activities and outcomes
  • Refers cases to Physician Reviewer when the treatment request does not meet medical necessity per guidelines

Job Tags

Permanent employment, Contract work, Temporary work,

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