Utilization Review Nurse Leader & Process Improvement

Beth Israel Lahey Health; Burlington (MA); On-site; USD 165,000 - 215,000; Full time

Job summary

Beth Israel Lahey Health seeks an experienced Utilization Review nurse leader in Massachusetts to oversee UR staff, ensure accurate patient status determinations, and collaborate with physicians to optimize admissions. You will coach staff, monitor audits, and drive process improvements across the Revenue Cycle.

The role requires a Bachelor's in Nursing (Master's preferred), current RN license, and 3+ years leadership in medical/surgical care with case management experience.

Qualifications

• Bachelor's degree in Nursing; active RN license in Massachusetts.
• 3+ years of medical/surgical nursing with leadership experience.
• Experience in case management or utilization management is desirable.

Responsibilities

• Oversee UR staff performance and coaching; conduct audits and performance evaluations.
• Collaborate with physicians and multidisciplinary teams to ensure appropriate admission status.
• Develop and implement process improvements; monitor outcomes and compliance.
• Manage vendor relationships, IT setup, and data reporting within Revenue Cycle.

Skills

Nursing leadership

Utilization Review

Communication

Quality Improvement

Revenue Cycle

Education

Bachelor's Degree in Nursing

Master's Degree preferred

Job description

Beth Israel Lahey Health seeks an experienced Utilization Review nurse leader in Massachusetts to oversee UR staff, ensure accurate patient status determinations, and collaborate with physicians to optimize admissions. You will coach staff, monitor audits, and drive process improvements across the Revenue Cycle.

The role requires a Bachelor's in Nursing (Master's preferred), current RN license, and 3+ years leadership in medical/surgical care with case management experience.