UM Outpatient Clinical Review Nurse, Health New England - Springfield
4 weeks ago
Job summary
The UM Outpatient Clinical Review Nurse contributes to the overall success of the Utilization Management department by performing clinical reviews for outpatient, including determining the member's overall health and reviewing care being delivered.
Performs pre-service concurrent and retrospective reviews of members for appropriate care and setting to determine overall health and appropriate level of care using applicable coverage documents and clinical guidelines Collects documents maintains review findings
Job description
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