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

aVhEVlBZekJ2MmJ2c2tvZFVKMVN0YnQv
  • 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,

Similar Jobs

Shootday

Event Photographer and Videographer Job at Shootday

 ...Shootday, a global photography, videography, and production platform, is looking for talented event photographers to join our freelance network. Job Overview: As an event Photographer and Videographer, you'll capture memorable moments at various events and deliver... 

Florida Health Care Association

Travel Nurse RN - Labor and Delivery Job at Florida Health Care Association

We are seeking a dedicated Travel Nurse RN - Labor and Delivery to join our team in High Point, NC. Provide exceptional patient care to mothers and newborns during labor, delivery, and postpartum stages. Monitor fetal and maternal health, administer medications,... 

Country Inn & Suites by Radisson

Housekeeping Attendant Job at Country Inn & Suites by Radisson

 ...ensuring the cleanliness, comfort, and overall guest experience within the hotel. Your primary responsibility will be to maintain a clean, sanitary, and welcoming environment for hotel guests. Need someone who can work weekends! Responsibilities: Perform a variety... 

Nihon-Teppan Co. Ltd.

Virtual Assistant (remote) Job at Nihon-Teppan Co. Ltd.

 ...This is an entry-level position perfect for job seekers with little experience but eager to learn and grow. Job Responsibilities: Process purchase orders for customers Record and reconcile inventory of products Track and manage incomings and outgoings... 

Baylor College of Medicine

Surgery - Trauma and Acute Care Surgery (- Instructor - Nurse Practitioner) Job at Baylor College of Medicine

 ...Summary The Trauma and Acute Care Surgery Division in the Michael E. DeBakey Department of Surgery is seeking a qualified Advanced...  ...work direction to support staff, including, but not limited to nurses, medical assistants, and unit managers Communicate with physicians...