Massachusetts Licensed Utilization Coordinator

Job Summary

A company is looking for a LPN/LVN Utilization Management Coordinator.

Key Responsibilities:

• Conducts timely clinical decision reviews for services requiring prior authorization across various clinical areas
• Applies established criteria to interpret clinical information and determine medical necessity
• Communicates review results to relevant stakeholders and ensures compliance with regulatory requirements

Required Qualifications:

• Associate degree
• Current MA clinical license in good standing
• 3+ years of combined clinical and utilization management experience
• Experience working in a health plan and/or with a care management platform is a strong plus