Top 53 Utilization review nurse Jobs in Somerville, Ma

Nurse Case Manager – Care Transitions (Full Time)
Beth Israel Lahey Health —Burlington, MA
- $38.11 - $98.23 an hour
- Full-time
- Nursing
- RN License
- Hospital
6d
Clinical Claim Review RN
Optum —Boston, MA
- $29 - $52 an hour
- 8 hour shift
- Remote
- 18 years or older
- RN License
- Customer service
- On-the-job training
Peer to Peer Utilization Management Nurse (32 Hours)
Mass General Brigham Incorporated —Somerville, MA
- $58,656.00 - $142,448.80 a year
- Part-time
- Remote
- Nursing
- RN License
- Bachelor of Science
- Opportunities for advancement
Quick Apply
11d
RN Care Coordinator (Per Diem)
Boston Medical Center —Brighton, MA
- $41.77 - $98.41 an hour
- Part-time
- Nursing
- RN License
- Writing skills
- Health insurance
- Dental insurance
Utilization Management RN
The General Hospital Corporation —Boston, MA
- $41.72 - $105.65 an hour
- Part-time
- Nursing
- RN License
- Mid-level
- Opportunities for advancement
Quick Apply
11d
Clinical Review Specialist
Mass General Brigham Community Physicians, Inc. —Somerville, MA
- $63,648.00 - $92,570.40 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Opportunities for advancement
Quick Apply
7d
Per Diem Case Manager
South Shore Health —Weymouth, MA
- $59.42 - $86.20 an hour
- Part-time
- Acute care
- Nursing
- Patient monitoring
- Paid holidays
Nurse Case Manager – Care Transitions (Part Time)
Beth Israel Lahey Health —Burlington, MA
- $38.11 - $98.23 an hour
- Part-time
- Nursing
- RN License
- Customer service
RN Case Manager - Inpatient Case Management Everett
Cambridge Health Alliance —Everett, MA
- Rotating weekends
- Nursing
- RN License
- Hospital
Sr Utilization Management Nurse RN - Field Position
Optum —Boston, MA
- $72,800 - $130,000 a year
- Full-time
- Nursing
- RN License
- Computer literacy
RN Reviewer
Cohere Health —Boston, MA
- $33 - $35 an hour
- Weekends as needed
- Remote
- Google Workspace
- Nursing
- RN License
- Paid parental leave
- Health savings account
Quick Apply
Case Manager RN – Per Diem
Beth Israel Lahey Health —Beverly, MA
- $36.00 - $79.12 an hour
- Day shift
- Nursing
- RN License
- Hospital
RN Case Manager
South Shore Health —Weymouth, MA
- $117,707.20 - $170,768.00 a year
- Full-time
- Acute care
- Nursing
- Patient monitoring
7d
RN Care Manager, Per Diem
Boston Medical Center —Boston, MA
- $38.05 - $75.33 an hour
- Part-time
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
Nurse Navigator, Acute Care Placement
Beth Israel Lahey Health —Boston, MA
- $39.14 - $101.14 an hour
- Weekends as needed
- Acute care
- Nursing
- Microsoft Excel
RN Case Manager per-diem
South Shore Health —Weymouth, MA
- $59.42 - $86.20 an hour
- Part-time
- Acute care
- Nursing
- Patient monitoring
- Paid holidays
Inpatient Discharge Care Manager (MNA)
Optum —Auburndale, MA
- $40.21 - $74.74 an hour
- Weekends as needed
- Acute care
- Nursing
- RN License
- Paid holidays
Quick Apply
RN Case Manager, 4W, 40 Hours (Days / 4x10 Hour Shifts / Every 6th Weekend)
Boston Medical Center —Boston, MA
- $38.05 - $75.33 an hour
- Full-time
- Nursing
- RN License
- Writing skills
- Health insurance
- Dental insurance
Registered Nurse, Home Health Program Nurse Coordinator
Greater Lawrence Family Health Center —Methuen, MA
- Nursing
- RN License
- Internal Medicine
- Tuition reimbursement
Quick Apply
Nurse Practitioner Anchor—Family NP Residency Program
Mattapan Community Health Center Inc —Boston, MA
- $100,000 a year
- Full-time
- Spanish
- CPR Certification
- Nursing
Quick Apply

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Nurse Case Manager – Care Transitions (Full Time)

Beth Israel Lahey Health -
Burlington, MA

Apply Now

Job Details

Full-time
$38.11 - $98.23 an hour
6 days ago

Qualifications

Computer operation
Direct patient care
RN License
Team leadership
BLS Certification
Medical-surgical
Conflict management
Typing

Full Job Description

Burlington, MA • Lahey Hospital and Medical Center • Full-time • Day

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

This role is full-time (40 hours per week) Monday through Friday with a Weekend Rotation shared among Staff.

Coordinates patient care utilization and discharge planning by applying clinical criteria, collaborating with care teams, and ensuring appropriate levels of care. Supports patient transitions, compliance, quality improvement, and regulatory standards while maintaining strong communication, customer service, and participation in organizational activities.

Job Description:

Essential Duties & Responsibilities including but not limited to:

1) Performs utilization review and discharge planning to inpatient admissions.
2) Applies Interqual, AEP and or other review criteria approved by the Clinic to accurately determine appropriateness for inpatient and outpatient care.
3) Utilizes clinical expertise to determine the appropriate level of care for patients. Leads the healthcare team in selecting appropriate, safe, hospital or alternative care options.
4) Works closely with Community Case Managers to collaborate regarding medically fragile and or high risk patients admitted to the clinic.
5) Identifies delay days and notifies Team Leader.
6) Reports serious occurrences and sentinel events to Risk Management.
7) Works with patients and families to facilitate post hospital care and develop plans to meet short and long-term needs.
8) Accurately manages observation status patients by working with physicians to ensure appropriate utilization.
9) Is part of the department’s Saturday, Sunday, holiday and beeper rotation as needed.
10) Supports all service line activities related to utilization and quality management.
11) Assists in the development and implementation of clinical pathways.
12) Adheres to all insurance, contractual and regulatory requirements as mandated.
13) Works with Lahey Clinic nursing, social work and other members of the healthcare team to coordinate and facilitate patient discharge.
14) Works with the Post Acute Care Coordinator to facilitate timely patient access to post acute care Services.
15) Participates in hospital or medical committees representing patient issues and department functions such as case management, utilization and CQI as requested.
16) Incorporates Lahey Clinic Guiding Principles , Mission Statement and Goals into daily activities.
17) Complies with all Lahey Clinic Policies.
18) Complies with behavioral expectations of the department and Lahey Clinic.
19) Maintains courteous and effective interactions with colleagues and patients.
20) Demonstrates an understanding of the job description, performance expectations, and competency assessment.
21) Demonstrates a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
22) Participates in departmental and/or interdepartmental quality improvement activities.
23) Participates in and successfully completes Mandatory Education.
17) Performs all other duties as needed or directed to meet the needs of the department.

Minimum Qualifications:

Education:

Registered Nurse, Bachelors Degree or commensurate experience preferred.

Licensure, Certification, Registration:

Must hold current Commonwealth of Massachusetts license as a Registered Nurse, and Basic Life Support (BLS)

Skills, Knowledge & Abilities:
In the absence of any of these skills, demonstrates the ability to be thoroughly trained to Proven leadership and project management experience and skill meet organizational standards.

Effective verbal communication, problem solving and conflict resolution skills.
Basic computer and typing skills.
Basic knowledge of Quality Improvement techniques.
Demonstrated ability to organize and work independently

Experience:

A minimum of three years of medical/surgical nursing care experience. Two years of case management or utilization management experience desirable.
Demonstrated ability to communicate effectively with medical and hospital staffs.

Pay Range:

$38.11 – $98.23

The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled

Job details

Employment: Full-time
Hours/Week: 40
Shift: Day
Category: Care Management / Patient Care Coordination
Pay Range: $38.11 - $98.23
FLSA: Non-Exempt
Req ID: JR98270

Apply Now

Refine Your Search

utilization review nurse jobs in somerville, ma

Nurse Case Manager – Care Transitions (Full Time)

Clinical Claim Review RN

Peer to Peer Utilization Management Nurse (32 Hours)

RN Care Coordinator (Per Diem)

Utilization Management RN

Clinical Review Specialist

Per Diem Case Manager

Nurse Case Manager – Care Transitions (Part Time)

RN Case Manager - Inpatient Case Management Everett

Sr Utilization Management Nurse RN - Field Position

RN Reviewer

Case Manager RN – Per Diem

RN Case Manager

RN Care Manager, Per Diem

Nurse Navigator, Acute Care Placement

RN Case Manager per-diem

Inpatient Discharge Care Manager (MNA)

RN Case Manager, 4W, 40 Hours (Days / 4x10 Hour Shifts / Every 6th Weekend)

Registered Nurse, Home Health Program Nurse Coordinator

Nurse Practitioner Anchor—Family NP Residency Program

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As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled

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