Posted Jul 23, 2026 · Last seen active Jul 24, 2026
About this role
Provides clinical review and escalation support for Utilization Management (UM) activities by triaging inquiries, calls, ticket submissions, and external requests - evaluating medical necessity, appropriateness of care, and compliance with regulatory and organizational guidelines. Collaborates with Nurse Reviewers, Medical Directors, providers, and interdisciplinary teams to address complex cases, facilitate timely determinations, and ensure accurate application of evidence-based criteria.
Requirements
Associate's Degree Nursing required or Bachelor's Degree Nursing preferred
Massachusetts Registered Nurse (RN) license
Basic Life Support (BLS) Certification preferred
At least 2-3 years of case management, utilization review, or discharge planning experience preferred
Proficient in Microsoft Office and industry-related software programs
Strong rapport and relationship building with patients and staff
Active listening and communication skills
Critical thinking and problem-solving skills
Benefits
Competitive salaries
Benefits package
Flexible work options
Career growth opportunities
Living in Somerville, MA
Somerville sits just north of Boston with a dense, creative energy rooted in its old industrial blocks. Davis Square and Union Square anchor the city's social life with independent venues, markets, and bars. It's a compact place where nurses find an easy community feel without straying far from Massachusetts' top medical networks.
/-71.1,42.39,10/600x300@2x?access_token=pk.eyJ1IjoiYWxlYzIxMzQ1IiwiYSI6ImNtczI3dHhxMDFlNmYzM3E4aGNzcjRrNGUifQ.VCDYsdKqT1jUEHiby03oPA)
