Base: $94,136.62 - $141,204.92; bonus/equity: not ...
Remote
Inpatient utilization management
Apply evidence-based criteria
Discharge planning
Point32Health Inc is seeking a Clinical Reviewer, Inpatient RN, to manage complex inpatient caseloads and ensure medically necessary care for its members. The role requires a licensed RN with significant clinical and utilization management experience, focusing on collaboration and effective decision-making
Job Summary
The Clinical Reviewer, Inpatient RN is responsible for managing clinically complex caseloads of members in inpatient settings, determining medical necessity and benefit coverage.
Key responsibilities include performing utilization management activities, applying clinical criteria, determining reimbursement methodology, and performing discharge planning.
Point32Health offers a competitive and comprehensive total rewards package including medical, dental, vision coverage, retirement plans, and paid time off.
Matching Summary
Match Score: 85
Point32Health Inc is seeking a Clinical Reviewer, Inpatient RN, to manage complex inpatient caseloads and ensure medically necessary care for its members. The role requires a licensed RN with significant clinical and utilization management experience, focusing on collaboration and effective decision-making.
Salary
Base: $94,136.62 - $141,204.92; Bonus/Equity: Not specified; Benefits: Medical, dental, vision, retirement, PTO, life and disability insurance, tuition program, well-being benefits
Skills & Requirements
Must-have
Inpatient utilization management
Apply evidence-based criteria
Discharge planning
Collaborate with providers
Documentation according to standards
Nice-to-have
Mentoring new staff
Subject matter expert
Professional growth and development
Key Requirements
Registered nurse with current, unrestricted Massachusetts RN license