Utilization Nurse Analyst: Improve Care & Reimbursement

Lahey Clinic Hospital, Inc.; Burlington (MA); Sur place; USD 52 000 - 135 000; Plein temps

Résumé du poste

Beth Israel Lahey Health seeks an experienced Utilization Analyst to validate medical necessity of hospital care. You will collaborate with physicians, payers and case management to ensure appropriate reimbursement in line with clinical care intensity.

Requirements include RN licensure, a Bachelor's degree desirability, and 5+ years in inpatient UR/CM, with CDIP/CCM/ACM desirable. Strong documentation, education, and communication skills are essential for success.

Qualifications

• Education: RN; Bachelor's degree desirable.
• Licensure: RN; CDIP/CCM/ACM highly desirable.
• Experience: 5+ years inpatient UR/CM experience; knowledge of payment methodologies and regulations.

Responsabilités

• Completes initial reviews of patient records within 24-48 hours of admission to determine medical necessity.
• Conducts daily follow-up reviews in accordance with payer requirements.
• Discusses status determinations with Attending physicians and documents justification.
• Educates physicians on documentation needs for appropriate level of care.
• Collaborates with case managers, nursing, coding, physicians and finance on issues.
• Analyzes statistics to identify opportunities for improvement in patient populations.
• Reviews external/internal data to trend, track, and educate for better outcomes.
• Prepares utilization review monitoring/trending reports for leadership.
• Instructs staff on best practices to ensure reimbursement based on care provided.
• Maintains clear reports of improvement results to medical and management staff.

Description du poste

Beth Israel Lahey Health seeks an experienced Utilization Analyst to validate medical necessity of hospital care. You will collaborate with physicians, payers and case management to ensure appropriate reimbursement in line with clinical care intensity.

Requirements include RN licensure, a Bachelor's degree desirability, and 5+ years in inpatient UR/CM, with CDIP/CCM/ACM desirable. Strong documentation, education, and communication skills are essential for success.