Inpatient Utilization Management Clinician in Boston, Massachusetts - #71877 | VanderHouwen

Description

Job Id: 71877

Inpatient Utilization Management Clinician
Our client is seeking a detail-oriented and collaborative Inpatient Utilization Management Clinician to support high-quality, evidence-based care decisions for inpatient services. The ideal candidate brings strong clinical judgment, analytical thinking, and the ability to effectively communicate with providers and interdisciplinary teams to ensure appropriate levels of care and smooth care transitions. This role requires a proactive professional who can independently manage complex case reviews while maintaining compliance with regulatory standards and delivering timely, member-focused outcomes.

This position is fully remote and may require occasional travel to Boston, Massachusetts for team meetings or training. The role may also require participation in an on-call rotation, including occasional evenings, nights, or weekends.

Inpatient Utilization Management Clinician Responsibilities

• Conduct concurrent and retrospective inpatient utilization reviews using evidence-based guidelines to determine medical necessity and appropriate levels of care.
• Gather and analyze clinical documentation from electronic medical records to support timely review determinations and authorizations.
• Collaborate with physicians, care management teams, and discharge planners to support effective care progression and appropriate discharge planning.
• Document review outcomes, communications, and authorization decisions while ensuring compliance with regulatory and contractual requirements.
• Escalate complex or non-qualifying cases to physician reviewers and participate in process improvement, team collaboration, and audit activities.

Inpatient Utilization Management Clinician Qualifications

• Active, unrestricted Registered Nurse (RN) license in the state of residence.
• Minimum of two years of utilization review experience using evidence-based clinical guidelines such as InterQual.
• Experience in managed care, inpatient review processes, and discharge planning coordination.
• Strong clinical judgment, analytical thinking, and the ability to manage complex cases while meeting regulatory timelines.
• Excellent communication, organization, and time management skills with the ability to work effectively in a remote environment.

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.

Meet VanderHouwen
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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!

VanderHouwen is an Equal Opportunity Employer and participates in E-Verify. VanderHouwen does not discriminate based on race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable local, state, or federal civil rights laws.

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