UM Regulatory Nurse Specialist, Health New England R40652 - Springfield, MA

Only for registered members Springfield, MA, United States

3 weeks ago

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Job summary

The UM Regulatory Nurse Specialist is responsible for delivering medical or behavioral health utilization management (UM) and coordination of care services to members in compliance with current accreditation requirements and quality standards,

Responsibilities

  • Pre-authorization review utilizing criteria to determine appropriateness of requested services
  • Admission review utilizing criteria to determine appropriateness of inpatient admission

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