Top 9 Utilization review nurse Jobs in Bourne, Ma

Utilization Nurse
Beth Israel Lahey Health —Plymouth, MA
- $37.14 - $82.22 an hour
- Day shift
- Nursing
- RN License
- Hospital
4d
Nurse Practitioner/Physician Assistant, Psych (Per Diem)
Cape Cod Healthcare —Hyannis, MA
- $153,565 - $169,076 a year
- 8 hour shift
- Nursing
- Psychiatry
- Hospital
Nurse Practitioner/Physician Assistant, Psych
Cape Cod Healthcare —Hyannis, MA
- $153,565 - $169,076 a year
- Full-time
- Nursing
- Psychiatry
- Addiction Medicine
2d
Psychiatric Nurse Practitioner
Harbor Health Services, Inc. —Hyannis, MA
- $129,970 - $195,955 a year
- 18 years or older
- Spanish
- Nursing
- Loan repayment program
- Disability insurance
Quick Apply
Registered Nurse | Review Analyst I | Remote | Detroit, MI | Contract
Walker Healthforce, LLC —United States
- Contract
- Remote
- Nursing
- RN License
- 3 years
- Health insurance
- Dental insurance
Quick Apply
1d
Utilization Management Reviewer
Amerihealth Caritas —United States
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Paid holidays
- Health insurance

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Utilization Nurse
Beth Israel Lahey Health —Plymouth, MA
Acts as a liaison between physicians and payers, coordinating peer-to-peer phone calls. Integrates clinical knowledge with billing knowledge to review, evaluate…
$37.14 - $82.22 an hour
4d
Clinical Analyst Appeals (Remote)
Beth Israel Lahey Health —Charlestown, MA
The Clinical Analyst will perform high-level clinical appeal for services in the inpatient and outpatient hospital setting, to ensure that Beth Israel Lahey…
$93,142 - $124,800 a year

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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
Director of Nursing
North Central Correctional Complex —Marion, OH
Valid driver’s license in the state of Ohio with an acceptable driving record required, unless waived by management. Must possess current CPR certification.
$115,000 a year
7d

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Utilization Nurse

Beth Israel Lahey Health -
Plymouth, MA

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Job Details

Per diem
$37.14 - $82.22 an hour
4 days ago

Qualifications

Inpatient experience
RN License
InterQual
Utilization management
Resource utilization in healthcare
Patient interaction
Acute care experience
Care coordination

Full Job Description

Plymouth, MA • Beth Israel Deaconess Hospital Plymouth • Per Diem • Day

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

Per Diem

Job Description:

Beth Israel Deaconess Hospital-Plymouth recognizes Integrity, Respect, Trust, Teamwork and Excellence as the Core Values of our organization. It is the philosophy of BID-Plymouth to follow the LEAN methodology in order to provide the full continuum of health care services and the best quality patient centered care.

Duties/Responsibilities:

Reviews admission data to establish the appropriate level of care using Interqual criteria.
Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient.
Conducts concurrent reviews to determine the continued need for acute care setting, appropriateness and timeliness of treatments/procedures and to optimize the potential for reimbursement.
Collaborates with the multidisciplinary team to assess and improve the denial management, documentation, and appeals process.
Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established guidelines for admission or continued stay.
Acts as a liaison between physicians and payers, coordinating peer-to-peer phone calls.
Collects and compiles data as required.

It is understood that this is a summary of key job functions and does not include every detail of the job that may reasonably be required.

Education/Experience Required:

Current MA RN licensure
Bachelor’s Degree in Nursing or advanced degree in healthcare preferred.
Three years recent, broad clinical experience in the hospital setting
Experience with utilization management within the last 3 years required
An understanding of the severity of an array illnesses, intensity of service, and care coordination needs
Ability to identify appropriateness of patients admission and level of care needs (inpatient & observation) utilizing Interqual criteria
Knowledge of Interqual required; Allscripts preferred
Strong interpersonal and negotiation skills demonstrated by a positive attitude, pleasant, professional and cooperative demeanor with patients, physicians, colleagues and insurance companies
Knowledge of government and insurance company reimbursement policies in regards to admission criteria, treatment and length of stay
Ability to work independently

Registration/Certification:

Current MA RN licensure

Physical/Environmental Requirements

This job requires frequent bending, carrying, pulling, pushing, reaching, standing, stooping, walking and lifting over 10 lbs. There will be occasional need for climbing stairs, lifting in excess of 50 – 100 lbs and sitting. Constant use of hearing, sight and speech. Frequent use of smell and touch. Frequent keyboard and telephone use. Constant concentration and problem solving.

Pay Range:

$37.14 – $82.22

This position is covered by a collective bargaining agreement. 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. The pay range for this position is established and governed by the terms of the applicable collective bargaining agreement. Employees hired into this position will receive compensation consistent with the terms of the applicable collective bargaining agreement.

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: Per Diem
Shift: Day
Category: Nursing
Pay Range: $37.14 - $82.22
FLSA: Non-Exempt
Req ID: JR100733

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Refine Your Search

utilization review nurse jobs in bourne, ma

Utilization Nurse

Nurse Practitioner/Physician Assistant, Psych (Per Diem)

Nurse Practitioner/Physician Assistant, Psych

Psychiatric Nurse Practitioner

Registered Nurse | Review Analyst I | Remote | Detroit, MI | Contract

Utilization Management Reviewer

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I want to receive the latest job alert for utilization review nurse in bourne, 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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