Top 195 Rn utilization manager Jobs in Boston, Ma

Utilization Review RN
Beth Israel Lahey Health —Boston, MA
- $38.11 - $98.61 an hour
- Full-time
- Nursing
- RN License
- Hospital
Care Transitions Utilization Review RN, Per Diem
Beth Israel Lahey Health —Boston, MA
- $38.11 - $98.61 an hour
- Call employer
- Nursing
- RN License
- Hospital
Care Transitions RN Case Manager
Beth Israel Lahey Health —Boston, MA
- $39.14 - $101.14 an hour
- Full-time
- Nursing
- RN License
- Hospital
Clinical Analyst Appeals (Remote)
Beth Israel Lahey Health —Charlestown, MA
- $93,142 - $124,800 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Customer service
Senior Consultant - Clinical Documentation Specialist
Deloitte —Boston, MA
- $110,700 - $218,300 a year
- Full-time
- Microsoft Word
- Nursing
- RN License
RN Case Manager, Inpatient Cardiology
Boston Children's Hospital —Boston, MA
- $93,538 - $149,656 a year
- Weekends as needed
- Nursing
- RN License
- Inpatient
- Health insurance
- Dental insurance
Nurse Care Manager
Hebrew SeniorLife —Boston, MA
- $78,576.07 - $117,864.10 a year
- Full-time
- Microsoft Word
- Spanish
- Nursing
- Dental insurance
- Tuition reimbursement
Quick Apply
Registered Nurse, Care Management
Boston Medical Center —Boston, MA
- Full-time
- Nursing
- RN License
- Writing skills
RN Case Manager, Inpatient
Boston Children's Hospital —Boston, MA
- $93,538 - $149,656 a year
- Weekends as needed
- Nursing
- RN License
- Inpatient
- Health insurance
- Dental insurance
RN Case Manager
Cambay Healthcare LLC —Beverly, MA
- $3,000 - $3,120 a week
- Contract
- RN License
- Hospital
- BLS Certification
Quick Apply
2d
Registered Case Manager
Bear Hill Rehabilitation & Nursing Center —Stoneham, MA
- Full-time
- Nursing
- Skilled nursing facility
- RN License
- Paid holidays
- Dental insurance
Quick Apply
11h
RN Case Manager
AMN Healthcare —Salem, MA
- $1,800 - $2,700 a week
- Part-time
- RN License
- BLS Certification
- Acute care experience
- Paid jury duty
- Paid holidays
17h
RN - Heart & Vascular ICU
Yale New Haven Health —Boston, MA
- Nursing
- RN License
- Customer service
- Dental insurance
- Paid time off
2d
RN Case Manager - Quick Offer
InfiCare —Salem, MA
- $65 an hour
- Full-time
- CPR Certification
- RN License
- BLS Certification
Quick Apply
19h
Registered Nurse Case Manager
Nora Concierge Care —Boston, MA
- $65 an hour
- Contract
- Vital signs
- RN License
- HIPAA
Quick Apply
6d
Assistant Director of Nursing, RN
Linden Ponds by Erickson Senior Living —Hingham, MA
- $120,000 - $150,000 a year
- 18 years or older
- Nursing
- Skilled nursing facility
- Health insurance
- Dental insurance
Quick Apply
RN - Behavioral Medicine / Behavioral Services
Yale New Haven Health —Boston, MA
- Nursing
- Psychiatry
- RN License
Case Manager RN LPN or Social Work License
Ledgewood Rehab & Skilled Nursing Center —Danvers, MA
- $35 - $51 an hour
- Full-time
- Nursing
- Skilled nursing facility
- RN License
- Paid holidays
- Health insurance
Quick Apply
1d
Behavioral Health RN
Yale New Haven Health —Boston, MA
- Nursing
- Psychiatry
- RN License
RN - Psychiatric Services / Psych Unit
Yale New Haven Health —Boston, MA
- Nursing
- Psychiatry
- RN License

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Utilization Review RN

Beth Israel Lahey Health -
Boston, MA

Apply Now

Job Details

Full-time
$38.11 - $98.61 an hour

Qualifications

RN License

Full Job Description

Boston, MA • Beth Israel Deaconess 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.

Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers. Partners with the health care team to ensure reimbursement of hospital admissions is based on medical necessity and documentation is sufficient to support the level of care being billed. Conducts concurrent reviews as directed in the hospital’s Utilization Review Plan and review of medical records to ensure criteria for admission and continued stay are met and documented. Along with other health care team members, monitors the use of hospital resources and identifies delays.

Job Description:

Essential Functions and Responsibilities:

1, Performs a variety of concurrent and retrospective utilization management-related reviews and functions to ensure that appropriate data are tracked, evaluated, and reported.

2. Collaborates with the health care team to determine the appropriate hospital setting (inpatient vs. outpatient) based on medical necessity.

3. Actively seeks additional clinical documentation from the physician to optimize hospital reimbursement when appropriate.

4. Works collaboratively with RN Case Managers to expedite patient discharge.

5. Maintains current knowledge of hospital utilization review processes and participates in the resolution of retrospective reimbursement issues, including appeals, third-party payer certification, and denied cases.

6. Monitors effectiveness/outcomes of the utilization management program, identifying and applying appropriate metrics, supporting the evaluation of the data, reporting results to various audiences, and implementing process improvement projects as needed.

7. Assists in the orientation and precepting of professional staff and colleagues as assigned.

8. Participates in analyzing, updating, and modifying procedures and processes to continually improve utilization review operations.

9. Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications, establishing personal networks; participating in professional societies.

10. Complies with federal, state, and local legal and certification requirements by studying existing and new legislation, anticipating future legislation; enforcing adherence to requirements; advising management on needed actions.

11. Reviews data of specific to utilization management functions and reports as requested.

12. Performs other related duties as required and directed.

Qualifications:

Required

Licensure as a Registered Nurse (RN), Massachusetts
Three years of recent clinical or utilization management experience

Preferred:

Bachelor’s degree in nursing or related healthcare fields.
Competence in standardized medical necessity criteria
Three years of recent case management or utilization management experience
ACM, CCM, or CMAC Certification

Knowledge, Skills, and Abilities:

Demonstrates expertise in the utilization management principles, methods, and tools and incorporates them into the daily operations of the organization. Understands, interprets and explains, and uses data for utilization management activities. Applies the principles and methods necessary to perform utilization management functions. Competency in applying the principles, methods, materials, and equipment necessary in
providing utilization management services. Demonstrates clinical expertise to effectively facilitate the evaluation of the level of care required. Develops and maintain strong collaborative working relationships with physicians, nursing colleagues, and other clinical professionals. Provide and receive feedback in a positive and constructive manner. Ability to understand, interpret, and explain data for utilization management functions Demonstrates highly developed written, verbal, and presentation skills. Possesses knowledge of care delivery systems across the continuum of care, including trends and issues in care reimbursement. Possesses mid to high-level proficiency in navigating the Electronic Medical Record and applications related to utilization management. Compliance with the Code of Ethics and Guide for Professional Conduct.

Pay Range:

$38.11 – $98.61

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: Nursing
Pay Range: $38.11 - $98.61
FLSA: Non-Exempt
Req ID: JR97330

Apply Now

Refine Your Search

rn utilization manager jobs in boston, ma

Utilization Review RN

Care Transitions Utilization Review RN, Per Diem

Care Transitions RN Case Manager

Clinical Analyst Appeals (Remote)

Senior Consultant - Clinical Documentation Specialist

RN Case Manager, Inpatient Cardiology

Nurse Care Manager

Registered Nurse, Care Management

RN Case Manager, Inpatient

RN Case Manager

Registered Case Manager

RN Case Manager

RN - Heart & Vascular ICU

RN Case Manager - Quick Offer

Registered Nurse Case Manager

Assistant Director of Nursing, RN

RN - Behavioral Medicine / Behavioral Services

Case Manager RN LPN or Social Work License

Behavioral Health RN

RN - Psychiatric Services / Psych Unit

I want to receive the latest job alert for rn utilization manager in boston, ma

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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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