One of America ’s premiere managed Medicaid companies has created a ground-floor career opportunity. This is a chance to join a major corporation, yet still impact the daily care of the neediest people. Based near Boston , MA you’ll enjoy office hours in a comfortable, modern office setting, a comprehensive corporate benefits plan, a competitive salary with bonus, and the knowledge that you are impacting the quality of care for thousands of people daily.

Perform utilization review for outpatient services. Review prior authorization requests utilizing approved criteria/guidelines to ensure the medical necessity of requested services/procedures.
Gather, collect, and document information necessary for the review of prior authorization requests received via fax or telephone from providers into designated systems according to procedure.
Refer cases not meeting criteria/guidelines for physician review. Communicate review outcomes to providers per protocol. Act as a clinical resource to referral staff. Provide patient and provider education.

Tags: Registered Nurse

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