Cityblock Health
RN - LTSS Case Management liaison (Hybrid - APX 75% Remote)
$100K–$105K
MA - Remote · Remote · Full-time · Posted Oct 13, 2026
- Experience
- 3 or more years of clinical experience.
- Education
- Graduate of an accredited school of nursing.
About the job
Owns clinical determinations and authorization support for members receiving Long Term Services and Supports (LTSS), coordinating reviews, appeals, and documentation with care teams and health plans.
What you'll do
- Review clinical and functional records, apply contract and state criteria, and write rationales for initial requests and annual redeterminations.
- Coordinate determinations with health plan Utilization Management teams and manage appeals, deadlines, and hearing preparation.
- Maintain accurate audit-ready records, manage review queues, and collaborate with care teams, service agencies, and health plan staff.
What they ask for
- Active, unrestricted Massachusetts RN or NP license in good standing; candidates must live in Massachusetts.
- Graduate of an accredited school of nursing.
- Understanding of MassHealth LTSS coverage criteria and Medicaid and Medicare Advantage authorization, appeal, and grievance processes.
- Working familiarity with LTSS, including home and community-based services and related supports.
Nice to have
- Direct experience in utilization management, clinical review, or medical necessity determination.
- Additional state licensure or multistate compact privileges; experience with functional assessment instruments; proficiency in multiple languages.
Pay
100,000 - 105,000 (USD; base salary)
Tools
MDS-HC, Commons, Athena, TalkDesk, ICD, CPT
Model-written summary · the original posting is authoritative