Utilization Management Rn Jobs

• Serving as a point person for Project Mosaic UM teams/work groups focusing on streamlined processes for capturing and documenting appropriate levels of care.
• Conducting proactive education on the importance of level of care/patient class
• Conduct clinical appeals if a case is denied inpatient level (prior to admission).
• Performing utilization review of hospital admissions and continued inpatient stays in accordance with established procedures, guidelines and criteria.
• Leading physician education efforts to inform level of care decisions
• Connecting with UM Case Manager on the concurrent side for any questions of consistency.
• Maintaining communication and collaboration among payers, providers, hospital departments and external agencies in order to promote continuity and coordination of care.
• Monitoring payer response times in relation to contractual agreements on turnaround in order to ensure appropriate time to conduct appeals.
• Creating templates for schedulers and physicians to use to help with peer to peer process.
• Performing utilization review of hospital admissions and continued inpatient stays in accordance with established procedures, guidelines and criteria.
• Developing a process from initial scheduling to discharge, to ensure level of care assignments are as accurate as possible.
• Serving as point person for clinical staff who have questions about level of care distinctions

To qualify, you must have:

• A BSN is required, a Master’s in a related Healthcare field or certification is a plus.
• The ability to work 40 hours per week, Monday through Friday, remotely, yet must still live within the immediate Boston/ New England area.
• Minimum 3-5 years of related Case Management or clinical experience.

Boston Children’s Hospital offers competitive compensation and unmatched benefits including flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.