Inpatient UM Clinician in Boston, Massachusetts - #72560 | VanderHouwen

Description

Job Id: 72560

Inpatient Utilization Management Clinician
Our client is seeking an experienced Inpatient Utilization Management Clinician to support inpatient care reviews, medical necessity determinations, and care coordination activities for members across a diverse healthcare population. This fully remote opportunity is ideal for a clinically strong Registered Nurse who thrives in a fast-paced environment, excels at critical thinking, and is passionate about ensuring members receive appropriate, high-quality care while meeting regulatory and compliance requirements.

This role is fully remote with possible occasional travel.

Inpatient Utilization Management Clinician Responsibilities

• Conduct concurrent and retrospective reviews of inpatient admissions using established clinical guidelines and evidence-based criteria.
• Evaluate medical necessity, level of care appropriateness, and benefit coverage while ensuring compliance with contractual and regulatory requirements.
• Collaborate with physicians, care management teams, discharge planners, and healthcare providers to support effective treatment planning and transitions of care.
• Review clinical documentation, gather additional information when needed, and facilitate timely authorization decisions.
• Escalate complex or non-standard cases to physician reviewers and medical leadership in accordance with established review processes.
• Monitor ongoing inpatient stays, identify barriers to discharge, and support progression to the most appropriate level of care.
• Maintain accurate and thorough documentation of review activities, clinical determinations, provider communications, and case outcomes.
• Ensure turnaround times and service standards are met for all utilization review activities.
• Assist with onboarding, mentoring, and knowledge sharing among utilization management team members as needed.
• Participate in quality improvement initiatives, audits, training programs, and cross-functional team meetings.

Inpatient Utilization Management Clinician Qualifications

• Active, unrestricted Registered Nurse (RN) license required.
• Current RN license in Massachusetts or New Hampshire, or an active multistate Compact RN license strongly preferred.
• Minimum of 2 years of utilization management, utilization review, or inpatient case management experience.
• Hands-on experience applying InterQual or similar evidence-based clinical review criteria.
• Experience within managed care, health plans, insurance, or payer environments preferred.
• Knowledge of inpatient authorization processes, medical necessity determinations, and healthcare regulations.
• Experience supporting discharge planning and transitions of care.
• Familiarity with Medicare, Medicaid, and related healthcare programs preferred.
• Strong critical thinking, clinical assessment, and decision-making skills.
• Excellent written and verbal communication skills with the ability to collaborate effectively across multidisciplinary teams.
• Proficiency with electronic medical records, case management systems, and Microsoft Office applications.
• Bachelor of Science in Nursing (BSN) preferred; equivalent nursing education and experience considered.

Compensation: (DOE)

VanderHouwen Contractors Enjoy Exceptional Benefit Perks!
As an eligible contract employee with VanderHouwen, you’ll have access to a full suite of benefits designed with your well-being in mind. Our comprehensive package includes medical, dental, vision, life insurance, short- and long-term disability, and a matching 401(k) to help secure your future.

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VanderHouwen is an award-winning, Women & Diversity-Owned, WBENC certified professional staffing firm. Founded in 1987, VanderHouwen places experienced professionals across the nation! Our recruitment teams specialize in either Technology and IT, Engineering, Human Resources, or Accounting and Finance career markets. Partner with us to land your next exciting career!

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