Senior RN Utilization Management Leader

Beth Israel Lahey Health; Winchester (MA); On-site; USD 166,000 - 198,000; Full time

Job summary

Beth Israel Lahey Health's Winchester Hospital seeks an experienced Utilization Management Specialist to support medical necessity reviews, discharge planning and system-wide process improvements. You will collaborate with physicians, payers, and care teams to ensure accurate documentation and appropriate patient placement.

Required RN with a BSN, MA license, and at least five years in inpatient case management and utilization review; leadership and education responsibilities are included, with

Qualifications

• Requires RN with Bachelor of Science in Nursing and MA license
• Five years RN experience including inpatient case management and utilization review
• Experience in staff education and pursuing case management certification within one year of hire

Responsibilities

• Co-Chair the hospital Utilization Review Committee and conduct initial reviews for medical necessity surveillance
• Manage denials, appeals, resubmissions, audits, and evolving workflows to support appropriate patient placement
• Educate physicians and staff on documentation, coding, and reimbursement and collaborate with interdisciplinary teams to improve outcomes and discharge planning

Skills

Strong communication

Clinical documentation

Team collaboration

English proficiency

Education

Bachelor of Science in Nursing

Master's Degree in a health care field

Tools

InterQual criteria

Job description

Beth Israel Lahey Health's Winchester Hospital seeks an experienced Utilization Management Specialist to support medical necessity reviews, discharge planning and system-wide process improvements. You will collaborate with physicians, payers, and care teams to ensure accurate documentation and appropriate patient placement.

Required RN with a BSN, MA license, and at least five years in inpatient case management and utilization review; leadership and education responsibilities are included, with