Nurse Reviewer - Massachusetts RN License

Gainwell is seeking a skilled Nurse Reviewer (RN) to support the Massachusetts contract. This role involves reviewing medical records to determine adherence to clinical guidelines and ensuring appropriate documentation supports medical necessity. The position offers flexible hours, career development opportunities, and a values-driven work environment. Nurses must hold an active MA RN license.

Requirements

• Proficient in computer and typing skills, including Microsoft Windows, Outlook, Excel, Word, PowerPoint, and internet browsers.
• Active, unrestricted RN licensure in Massachusetts required; compact multistate RN license strongly preferred.
• Minimum of 5+ years clinical experience in an inpatient hospital setting.
• Minimum of 2+ years utilization review or claims auditing experience.
• Experience with Milliman or InterQual criteria required.
• Ability to work standard business hours with frequent interactions across teams and departments.
• Flexibility to work extended hours when needed.
• Ability to work standard business hours, loud noises, and recording devices.

Benefits

• Health benefits
• Paid time off
• Standard work schedule
• Remote work