Top 7 Utilization management nurse Jobs in Pittsfield, Ma

Case Manager - Social Services
Berkshire Health Systems —Pittsfield, MA
- $45.25 an hour
- Full-time
- CPR Certification
- Nursing
- RN License
Nursing Supervisor - Community Services
Brien Center for Mental Health —Pittsfield, MA
- $44.99 - $45.00 an hour
- CPR Certification
- Nursing
- Addiction Medicine
Nurse Practitioner/Physician Assistant-Palliative Care
Berkshire Health Systems —Pittsfield, MA
- $54.81 an hour
- Full-time
- Nursing
- Mid-level
- Outpatient experience
- Health insurance
- Dental insurance
13d
Travel Case Management RN
Fastaff —United States
- Up to $2,826 a week
- Full-time
- Background check
- Nursing
- RN License
- Mileage reimbursement
- Health savings account
Quick Apply
2d
Utilization Management Reviewer
Amerihealth Caritas —United States
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Paid holidays
- Health insurance

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Clinician – Community Services
Brien Center for Mental Health —Pittsfield, MA
Massachusetts LCSW, LICSW, LMHC, O.T. or active Registered Nursing license. Also classified as a Licensed-Practitioner of the Healing Arts (when applicable),…
From $70,000 a year
Nursing Supervisor - Community Services
Brien Center for Mental Health —Pittsfield, MA
Adheres to all applicable state and federal regulations; ensures compliance with the organization’s policies and procedures, code of conduct, and all applicable…
$44.99 - $45.00 an hour

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Registered Nurse (RN) - Neurology - Med Surg Unit - Springfield Regional Medical Center - Weekend Only
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Current RN license in state they are working or covered by compact (required). Recognizes own limitations and seeks assistance and acquires information to…
Nurse Practitioner (NP)
Alternate Solutions Health Network —Chillicothe, OH
Active RN license in state of practice and current certification as an NP required. Provides cover for the physician when they are absent, to include answering…
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2d

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Case Manager - Social Services

Berkshire Health Systems -
Pittsfield, MA

Apply Now

Job Details

Full-time
$45.25 an hour

Qualifications

Collaborate with healthcare professionals
Appeals
Computer operation
CPR Certification
Patient resource coordination
Data analysis reporting
Medicare
Utilization review
Case assessment
RN License
Maintaining patient confidentiality
BLS Certification
CMS
Collaborating with government agencies
Community resource coordination in health services social work
Data summary reports
Change management
Medicaid health insurance
Managing patients as a nurse case manager
Transitional care planning in clinical case management
Acute care facility experience
CMS regulatory compliance
Medicare regulations
Utilization management
Resource utilization in healthcare
Medical insurance appeals management
Multidisciplinary team collaboration for treatment planning
Concurrent review in utilization management
Computer skills
Medicaid regulations

Full Job Description

DEFINITION/PRIMARY FUNCTION
- The Case Manager is responsible for managing the healthcare needs, facilitation and achievement of quality and cost outcomes of all patients within Berkshire Medical Center, across the continuum. The case manager, utilizing a multidisciplinary team approach, negotiates, procures, coordinates and monitors services and resources needed by patients. The case manager is responsible for reviewing the patient at admission, and in some instances prior to admission, and concurrently throughout the hospital stay for the appropriate level of care and utilization of resources. The case manager will perform transition care planning activities to secure appropriate post hospital care arrangements and will monitor the patient during the course of their hospitalization. The case manager participates with the performance improvement initiatives undertaken by Berkshire Health Systems
POSITION QUALIFICATIONS (Minimum qualifications are required unless stated otherwise.)
- Experience:
  - Three years clinical experience in acute care in areas such as internal medicine, surgery, orthopedics, mother/child, cardiology, and oncology.
  - Three years clinical experience in Rehab Setting, Home Health and Long-Term Care would be considered.
  - Ability to perform a comprehensive admission and discharge risk assessment related to quality, financial, payer benefit allowances and limitations, risk management and patient satisfaction.
  - Case Management experience required for weekend, temporary and per diem positions.
  - Experience specializing in utilization management (levels of care knowledge and demonstrable competence with evidence-based criteria tools), discharge planning to entities throughout a continuum of care, previous care management or third-party insurance review required
  - Current knowledge of CMS (levels of care determinations), appeal rights & DPH regulations required
  - Current knowledge of Ma Pro QIO (appeals) required
  - Knowledge of regulatory and accreditation organizations such as Joint Commission, DPH and HealthGrades preferred
- Education and Training:
  - Associate degree is Nursing required.
  - Bachelor’s Degree in Nursing within four years of hire.
- License, Certification & Registration:
  - RN - Currently licensed as an RN in Massachusetts
  - CPR
  - CCMACM – Certified Case Manager or Accredited Case Manager within two years of hire
  - RN-BC – Registered Nurse, Board Certification in Case Management with two years of hire
- Other Requirements:
  - Organizational skills. Proven ability to analyze and present data. Computer literacy. Ability to plan, implements, and evaluate change.
  - Data management skills preferred
  - Proven excellent interpersonal and communication skills
  - Ability to maintain confidentiality
  - Proven collaboration & negotiation skills with providers, patients, families, insurance organizations and government agencies
  - Proven ability to work independently
  - Proven excellent organizational skills
  - Demonstrated ability to establish and maintain relationships with physicians
  - Knowledge of local community resources required
  - Knowledge of Medicare, Medicaid, third party commercial payers and reimbursement required
  - Computer experience required with proven ability to manage multiple open applications
  - Skills in data comprehension, research, analysis, interpretation, and judgement necessary to prepare a comprehensive summary report for files, management, legal and/or regulatory agencies upon request

Location: Berkshire Health Systems · BMC Case Mgt-Social Svcs
Schedule: Full Time, Shift 1, 7:00am-3:30pm

Apply Now

Refine Your Search

utilization management nurse jobs in pittsfield, ma

Case Manager - Social Services

Nursing Supervisor - Community Services

Nurse Practitioner/Physician Assistant-Palliative Care

Travel Case Management RN

Utilization Management Reviewer

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