Per Diem RN: Case Review & Utilization Coordinator

Brigham and Women's Faulkner Hospital; Boston (MA); On-site; USD 57,000 - 138,000; Full time

Job summary

Brigham and Women's Faulkner Hospital in Boston is seeking a Per Diem RN to support case management. The role requires performing the six essential activities across the continuum of care to ensure safe, cost-effective post-discharge transitions and to complete audits and appeals as needed.

The position requires a BSN and MA RN license, with 3 years in Utilization Review/Case Management (4+ preferred) and 5 years of acute care nursing ( CCM preferred).

Qualifications

• BSN required.
• Current MA RN license.
• 3 years of Utilization Review/Case Management; 4+ years preferred.
• 5 years of Acute Care Nursing required.
• 6+ years CCM preferred.

Responsibilities

• Perform utilization review to evaluate appropriate level of care and fax reviews to prevent denials.
• Collaborate with patient/family and interdisciplinary team for discharge planning.
• Place and track referrals to post-acute care and document interactions.
• Interact with third party payers daily and manage documentation for Medicare status changes.
• Coordinate denials and appeals and ensure timely communications.

Skills

Utilization Review

Case Management

Acute Care Nursing

CCM

Education

BSN

Massachusetts RN License

Job description

Brigham and Women's Faulkner Hospital in Boston is seeking a Per Diem RN to support case management. The role requires performing the six essential activities across the continuum of care to ensure safe, cost-effective post-discharge transitions and to complete audits and appeals as needed.

The position requires a BSN and MA RN license, with 3 years in Utilization Review/Case Management (4+ preferred) and 5 years of acute care nursing ( CCM preferred).