RN Utilization Review Analyst

Beth Israel Lahey Health; Burlington (MA); Sur place; USD 53 000 - 135 000; Plein temps

Résumé du poste

Beth Israel Lahey Health is seeking an experienced Utilization Analyst to validate the medical necessity of hospital care. The role collaborates with physicians, payers and inpatient case management to ensure proper reimbursement aligned with the intensity of medical care provided.

Responsibilities include initial and daily reviews, physician education on documentation, and trend analysis to identify improvement opportunities. RN with CDIP/CCM desirable; 5+ years UR/CM experience preferred.

Qualifications

• RN is required; CDIP, CCM highly desirable.
• Knowledge of payment methodologies, federal and state regulations, organization and communication skills required.

Responsabilités

• Completes initial reviews of patient records within 24–48 hours of admission to evaluate medical necessity.
• Conducts follow-up reviews of patients daily per payer requirements.
• Educates physicians and healthcare providers on documentation needs and reporting for appropriate reimbursement.
• Collaborates with case managers, nursing staff, coding team, physicians and finance on relevant issues.
• Assists with preparation and presentation of utilization review monitoring/reports for leadership review.

Formation

RN

Bachelor's degree

Description du poste

Beth Israel Lahey Health is seeking an experienced Utilization Analyst to validate the medical necessity of hospital care. The role collaborates with physicians, payers and inpatient case management to ensure proper reimbursement aligned with the intensity of medical care provided.

Responsibilities include initial and daily reviews, physician education on documentation, and trend analysis to identify improvement opportunities. RN with CDIP/CCM desirable; 5+ years UR/CM experience preferred.