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Nurse Reviewer - Remote
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![]() United States, Massachusetts, Shrewsbury | |||||||||
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Nurse Reviewer - Remote Minimum Salary
US-MA-Shrewsbury Job Location
1 month ago(6/28/2024 12:15 PM)
Overview POSITION SUMMARY: Under the general direction of the Associate Director or the Clinical Leader or designee, the Nurse Reviewer is responsible for medical necessity determinations of provider-requested services (prior authorization requests) consistent with established procedural standards and MassHealth program rules and regulations. Responsibilities ESSENTIAL FUNCTIONS:
Review Prior Authorization requests, as assigned, and make clinically appropriate decisions and medical necessity determinations to adjudicate these requests, based on established procedural standards and MassHealth program rules, regulations and clinical guidelines.
Qualifications REQUIRED QUALIFICATIONS:
OR
Additional Information PREFERRED QUALIFICATIONS:
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