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Utilization Reviewer - Registered Nurse (Remote Schedule)
In the heart of Massachusetts' health landscape stands an organization dedicated to transforming lives. With a legacy deeply rooted in community care, innovation, and steadfast commitment, this entity is reshaping the narrative of health advocacy. Guided by a mission to empower individuals and families, it seamlessly integrates cutting-edge solutions with a genuine commitment to member-centric experiences. It's not merely about coverage; it's about fostering vitality, resilience, and a future where everyone thrives. Welcome to a space where the pursuit of well-being is an art, and each individual is the masterpiece.
What To Know:
- Earn up to $45 per hour in compensation
- Begin with a temporary position, offering potential for a permanent role
- Opportunity to collaborate with a leading health insurance provider
- Remote work arrangement (only candidates currently living in Massachusetts will be considered)
Responsibilities:
- Perform thorough reviews, emphasizing utilization management, discharge planning, care coordination, and clinical outcomes
- Assess members' clinical status and benefits to formulate cost-effective, medically necessary care plans
- Collaborate in a multidisciplinary team to achieve top-tier care coordination for members
- Engage with treatment providers, oversee clinical quality, and adhere to insurance regulations and requirements
Qualifications:
- 3 to 5 years of experience doing Utilization Review
- Active RN/LPN license in Massachusetts is required
- Must be currently living in Massachusetts
- RN/LPN license in another state is a plus
There are no costs for candidates utilizing our services as our clients pay for all related hiring fees. All ProPivotal job postings are either actual positions we had available at the time of posting and/or are representative of positions we typically fill or expect to fill. If you see a job that interests you, respond to the ad or give us a call so that we can help you find a job you'll love. As one of the area's largest staffing firms, we help 2,500 people find jobs a year so chances are good that we can help you too.
ProPivotal is an equal opportunity employer and considers qualified applicants for employment regardless of race, gender, gender identity, gender expression, age, color, religion, disability, veteran's status, sexual orientation, or any other protected factor.
ProPivotal is committed to excellence in customer service. For many years ProPivotal has enthusiastically followed an award-winning system of measuring the quality and loyalty of our client and candidate relationships. Our system is based on a net promoter score methodology. We want to know what we did right, and what we could do better next time - if you're a client, a job seeker, or a temporary employee, your experience with ProPivotal matters to us!
