Utilization Management RN The Hollister Group - 4.2 Somerville, MA Job Details Full-time $45 - $50 an hour 1 hour ago Qualifications Nursing Electronic health records (EHR) management RN License Managed care organization experience Patient management software Documentation tools Bachelor's degree InterQual Utilization management Resource utilization in healthcare SharePoint Productivity software Nursing Full Job Description Are you a dedicated Registered Nurse passionate about delivering quality patient care and navigating complex healthcare systems? Our client, a leading organization in healthcare insurance, is seeking experienced Utilization Management RNs to play a vital role in reviewing prior authorization requests, determining medical necessity, and ensuring efficient benefit coverage across diverse lines of business. This is an excellent opportunity to make an impact within a dynamic, remote environment where your expertise will support improved patient outcomes and streamline clinical operations.

Compensation:

$45.00-50.00/hour

• Listed not guaranteed - potential offers vary based on experience level, qualifications, and internal equity and may be outside of this range. This is a remote contract position.

Responsibilities:

Evaluate prior authorization requests through thorough medical necessity assessments and benefit coverage reviews. Make informed approval decisions within scope, identifying cases requiring physician review and completing determinations accordingly. Stay informed about healthcare trends and ensure compliance with evolving guidelines and policies. Collaborate effectively with healthcare providers, colleagues, and patients, maintaining professionalism and confidentiality. Leverage industry-specific tools such as InterQual® and familiar software platforms to enhance workflow and documentation. Demonstrate analytical thinking to identify strengths and weaknesses in healthcare solutions while managing multiple priorities efficiently.

Requirements:

Active Registered Nurse license in Massachusetts. Bachelor's degree in Nursing or related healthcare field. 2-4 years of experience in Utilization Management and managed care environments. Familiarity with various lines of business, including Medicaid, Medicare, and Commercial products. Knowledge of InterQual® criteria in managed care patient settings. Strong communication skills, both verbal and written, with a focus on respectful dialogue. Technological proficiency with Microsoft Office Suite, SharePoint, industry-specific applications, and electronic health records. Self-motivated and highly organized with the ability to manage multiple tasks independently. Our Commitment to Inclusion & Belonging The Hollister Group is an equal opportunity employer. We welcome and encourage applications from people who are under-represented in their respective occupation or position. #HGP #LI-KM1