Utilization Review RN - Drive Care & Reimbursement

Beth Israel Lahey Health; Boston (MA); Presencial; USD 108 968 000 - 282 408 000; Tempo integral

Resumo da oferta

Beth Israel Lahey Health in Massachusetts is seeking an RN Utilization Review professional to partner with admitting physicians and the care team. You will determine admission status, support medical necessity for hospital stays, and help ensure proper documentation for reimbursement.

You will conduct concurrent and retrospective reviews and identify opportunities to optimize resource use. The role requires MA RN licensure and at least three years of clinical or utilization management

Qualificações

• RN licensure in Massachusetts
• Three years of recent clinical or utilization management experience
• Ability to work with physicians and healthcare teams to ensure compliant documentation and reimbursement

Responsabilidades

• Perform concurrent and retrospective utilization reviews to track, evaluate, and report data.
• Collaborate with care teams to determine inpatient vs outpatient settings based on medical necessity.
• Expedite patient discharge in collaboration with RN Case Managers.
• Maintain knowledge of utilization review processes and support resolution of reimbursement issues.

Conhecimentos

Utilization management

Data interpretation

Written and verbal communication

Collaboration with physicians

Formação académica

Bachelor’s degree in nursing or related healthcare fields

Ferramentas

EMR systems

Descrição da oferta de emprego

Beth Israel Lahey Health in Massachusetts is seeking an RN Utilization Review professional to partner with admitting physicians and the care team. You will determine admission status, support medical necessity for hospital stays, and help ensure proper documentation for reimbursement.

You will conduct concurrent and retrospective reviews and identify opportunities to optimize resource use. The role requires MA RN licensure and at least three years of clinical or utilization management