Utilization Review RN- Hospital Case Management

Baystate Health; Springfield (MA); Híbrido; USD 40.000 - 68.000; Jornada completa

Descripción de la vacante

Baystate Health is seeking a Hospital Utilization Review RN to coordinate care, and ensure quality and financial outcomes for a designated patient population. The role involves review and appeal responses, admission and concurrent reviews for certification, and ongoing payer communication to optimize reimbursement for Baystate Springfield.

Inpatient unit schedule includes 40 hours with every third weekend and holiday.

Formación

• Current Massachusetts RN license is required.
• BSN preferred.
• 3–5 years acute care nursing or inpatient case management experience required.
• Experience in utilization review processes is strongly preferred.

Responsabilidades

• Coordinate patient care with Baystate Health resources to optimize quality and financial outcomes.
• Respond to medical and behavioral health appeals inquiries and requests.
• Conduct admission and concurrent reviews to obtain certification.
• Collaborate with payers to optimize reimbursement potential for the hospital.
• Assist with resolution of patient complaints regarding charges while ensuring compliance.

Conocimientos

Nursing

Utilization review

Case management

Acute care

Communication

Educación

Diploma in Nursing

BSN preferred

Descripción del empleo

## Utilization Review RN- Hospital Case ManagementApply: Springfield, Massachusetts: Full time: Posted Today: R45343## Baystate Health is seeking **Hospital** **Utilization Review RN** to join our growing healthcare teams.The **Utilization Review RN** is a registered professional nurse responsible for the coordination of care, quality and financial outcomes for a designated population of patients. The UR RN coordinates use of BH resources to assure that patients are provided optimal quality of care and service, researches and responds to all medical and behavioral health appeal inquiries and requests, in accordance with contractual, account, policy and accreditation requirements, conducts admission and concurrent reviews to obtain certification, facilitates and coordinates with internal and external customers in a proactive manner to bring review/appeal to satisfactory resolution, collaborates with payers through ongoing written and verbal communication to optimize the reimbursement potential for Baystate Franklin Medical Center, coordinates resolution of patient complaints regarding questionable and/or inappropriate charges, adheres to system and department compliance policies and any applicable laws and regulations and provides high quality customer service. **Schedule**Inpatient Unit - 40 hours - Every 3rd Weekend & Holiday**Required Work Experience:*** Current Massachusetts Registered Nurse (RN) license* BSN preferred* 3-5 years acute care clinical nursing experience or inpatient Case Management experience required* Experience in utilization review process and utilization management strongly preferred **Benefits That Support You** At Baystate Health, you get the best of both worlds: the resources, stability, and career opportunities of a large integrated healthcare system with the supportive culture of a community-focused organization.Depending on eligibility, benefits may include:* Competitive Pay & Benefits: Medical, dental, and vision coverage, including local Health New England plans.* Tuition & Training: Tuition assistance, CEUs, and professional development opportunities.* Career Growth: Clinical advancement, leadership development, and internal career opportunities.* Regional Opportunities: Career options across Baystate Health hospitals, practices, and services throughout western Massachusetts.* Retirement: Retirement savings and employer match.* Paid Time Off: Generous PTO for eligible employees.Whether you provide direct patient care, clinical services, or operational support, your work at Baystate Health helps improve the health of the communities we serve.**Education:**Diploma in Nursing (Required)**Certifications:**Registered Nurse - State of MassachusettsState of MassachusettsState of Massachusetts**Compensation**Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries may vary by position and will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range. Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees.Minimum - Midpoint - Maximum$40.65 - $53.96 - $67.26**Equal Employment Opportunity Employer**Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.