[Hiring] Inpatient Utilization Management Clinician @WellSense Health Plan

Role Description

The Inpatient Utilization Management Clinician is responsible for evaluating all inpatient medical treatments for medical necessity, monitoring ongoing treatment, facilitating discharge planning to ensure smooth and successful transitions of care, and collaborating with care management and medical directors to support members in achieving optimal health outcomes.

Qualifications

• Active, unrestricted RN license in state of residence.
• Nursing degree or diploma required, bachelor’s degree in nursing preferred.
• Bachelor’s degree.
• RN license in state of MA, NH or compact license.
• Medicare and Medicaid knowledge.

Requirements

• 2+ years utilization review experience and evidence-based guidelines (InterQual Guidelines).
• Managed care experience.
• Experience performing discharge planning.
• Active, unrestricted RN license in state of residence.
• Pre-employment background check.
• Ability to take after hours call, including evening/nights/weekends.

Benefits

• Full-time remote work.
• Competitive salaries.
• Excellent benefits.
• Generous total compensation including medical, dental, vision, pharmacy benefits.
• Merit increases.
• Flexible Spending Accounts.
• 403(b) savings matches.
• Paid time off.
• Career advancement opportunities.
• Resources to support employee and family wellbeing.

Working Conditions and Physical Effort

• Fully remote position with possible travel to the Charlestown, MA office for team meetings and training sessions.
• Fast paced and dynamic work environment requiring adaptability and focus.
• Minimal physical effort required; primarily desk-based tasks such as documentation and virtual meetings.
• Regular and reliable attendance is essential.

Compensation Range

$35.58 - $51.68. This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer.