Job Overview – Utilization Review Nurse (Prior Authorization) Location: Boston, MA (Remote) Job #48529 | Type: Temporary | Salary: $47/hour Atlantic Group is hiring a Utilization Review Nurse (Prior Authorization) to support utilization review, prior authorization, and medical necessity determinations within a managed care environment. The role focuses on reviewing inpatient and outpatient service requests, applying evidence‑based guidelines, and ensuring timely, compliant care decisions. The Prior Authorization Nurse will utilize InterQual criteria, EMR systems, and clinical judgment to support patient outcomes and regulatory compliance. Responsibilities Perform pre‑certification, concurrent, and retrospective reviews to determine medical necessity. Apply clinical guidelines and policies to assess appropriateness of care. Communicate with providers and internal teams to support timely authorization decisions. Maintain accurate and timely records of all review activities and decisions. Refer complex or non‑qualifying cases to physician reviewers as needed. Qualifications Associate’s or Bachelor’s degree in Nursing from an accredited program. Active, unrestricted Registered Nurse (RN) license in the state of residence or compact license. 2+ years of prior authorization or utilization review experience within a managed care environment. Familiarity with Medicare, Medicaid, and evidence‑based guidelines such as InterQual (preferred). Proficiency in EMR systems, Microsoft Office, and clinical data management tools. Strong clinical judgment, critical thinking, communication skills, and ability to work independently in a remote setting. Application Notice Qualified candidates will be contacted within 2 business days of application. If a candidate does not meet the above criteria, Atlantic Group will keep your resume on file for future opportunities and may contact you for further discussion. #J-18808-Ljbffr
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