This requisition is being used as a sourcing tool and does not have an open vacancy. Your application to this req will add you to a pool of candidates for potential future openings. We still encourage you to apply directly to positions you feel best meet your background, as this will not replace your application for other openings. We welcome applications from all levels of Clinical Nurse Reviewers and for all of our locations.
Example of a grade 45 Clinical Nurse Reviewer job description:
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.