GENERAL SUMMARY OF POSITION:
Under the general supervision of the Associate Director, or designee, the Nurse Reviewer II is responsible for assessing clinical eligibility, prior authorizations and providing interval case consultation by reviewing medical records, assessing the client’s needs, and providing resource support for program participants/applicants. This position ensures that eligible individuals are referred to and receive appropriate services based on medical necessity determinations and program/waiver regulations.
UMMS seeks a nurse who works autonomously and self-directed to conduct in-person clinical eligibility determinations for four (4) EOHHS/MassHealth Home and Community Based Service (HCBS)Waivers in Western and Central Massachusetts. The position allows the nurse to work remotely with travel to facilities to conduct assessments 3-4 times per week.