RN Utilization Review Specialist

IntelyCare; Quincy (MA); On-site; USD 70,000 - 90,000; Full time

Job summary

Mass Digital Health is seeking a Utilization Review Nurse in Quincy, Massachusetts. This role involves evaluating patients for appropriate admission type and collaborating with healthcare teams to manage care effectively. The ideal candidate will have a strong clinical background and be proficient in communication and service coordination.

This position requires at least two years of RN experience in care management or utilization management. The Utilization Review Nurse will work in a fast-paced environment focused on improving patient care and clinical documentation.

Qualifications

• Minimum of two years experience as an RN preferred.
• Minimum two years in care management and/or utilization management preferred.
• Background in Med Surg and Utilization Review preferred.
• Ability to multi-task and adapt to a fast-paced environment.

Responsibilities

• Evaluates medical records for appropriateness of admission status.
• Works with care managers, attending physicians, and providers.
• Negotiates with insurers over acute hospital care needs.
• Conducts self-auditing of medical records and provides peer consultation.

Skills

Clinical knowledge

Negotiation skills

Communication skills

Interpersonal skills

Problem-solving skills

Education

Registered Nurse with current license

Tools

Electronic mail

Time and attendance software

Learning management software

Job description

Mass Digital Health is seeking a Utilization Review Nurse in Quincy, Massachusetts. This role involves evaluating patients for appropriate admission type and collaborating with healthcare teams to manage care effectively. The ideal candidate will have a strong clinical background and be proficient in communication and service coordination.

This position requires at least two years of RN experience in care management or utilization management. The Utilization Review Nurse will work in a fast-paced environment focused on improving patient care and clinical documentation.