GENERAL SUMMARY OF POSITION:
Under the general direction of the Director or designee, the Clinical 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. The Clinical Nurse Reviewer will conduct case reviews, record reviews, and medical necessity determinations and will support Board of Hearing appeals. This individual will engage in Quality Improvement activities related to the prior authorization process and protect the integrity of the program.
***NO PARKING AVAILABLE***