Stand out for this role — generate a tailored resume and cover letter in about a minute.
Massachusetts Health & Hospital Association offers a leadership role in Utilization Management, supervising onsite UM staff to coordinate patient care. You will work with physicians and interdisciplinary teams through face-to-face consultations, bedside rounds, and ED assessments to determine appropriate level of care and medical necessity.
The role involves concurrent reviews, documentation, and reducing avoidable hospital days while guiding staff, overseeing workflow, and supporting quality
The role involves leading and supervising onsite Utilization Management (UM) staff, ensuring effective coordination across patient care stages, and maintaining quality outcomes.
Responsibilities include collaborating with physicians and interdisciplinary teams through face-to-face consultations, bedside rounds, and emergency department assessments to determine the appropriate level of care and medical necessity.
Key duties encompass performing concurrent reviews using established criteria, issuing necessary documentation, and minimizing avoidable hospital days to prevent financial loss.
The leader provides guidance, coaching, and mentorship to staff, oversees staffing and workflow, manages quality assurance activities, and supports performance improvement initiatives.
Qualifications include RN licensure, knowledge of healthcare regulations, and experience in utilization review or case management.
Skills required are clinical expertise, strong communication, teamwork, conflict resolution, and proficiency with electronic health records (Epic).
Overall, the role is critical in optimizing hospital throughput, ensuring compliance, and delivering high-quality patient care through real-time clinical decision-making and staff leadership.