Utilization Review RN: Optimize Admissions & Reimbursement

Beth-Israel-Lahey-Health; Boston (MA); On-site; USD 79,000 - 205,000; Full time

Job summary

Beth Israel Deaconess Medical Center in Boston, MA is seeking a Utilization Review RN to collaborate with admitting physicians, determine admission status, and ensure medical necessity and documentation support for hospital stays.

You will perform concurrent and retrospective reviews, work with RN Case Managers to expedite discharge, monitor utilization metrics, and stay current with regulations. This is a full-time, day-shift position with competitive compensation.

Qualifications

• Licensed RN in Massachusetts.
• Three years of clinical or utilization management experience.

Responsibilities

• Perform concurrent and retrospective utilization management reviews to track, evaluate, and report data.
• Collaborate with health care teams to determine inpatient vs. outpatient setting based on medical necessity.
• Obtain additional clinical documentation from physicians to optimize reimbursement when appropriate.
• Work with RN Case Managers to expedite patient discharge and improve throughput.
• Maintain knowledge of utilization review processes and participate in resolving reimbursement issues.

Skills

Utilization management

RN licensure

Communication skills

EMR proficiency

Data interpretation

ACM/CCM/CMAC certification

Education

Bachelor's degree in nursing or related healthcare fields

Tools

Electronic Medical Record (EMR) systems

Job description

Beth Israel Deaconess Medical Center in Boston, MA is seeking a Utilization Review RN to collaborate with admitting physicians, determine admission status, and ensure medical necessity and documentation support for hospital stays.

You will perform concurrent and retrospective reviews, work with RN Case Managers to expedite discharge, monitor utilization metrics, and stay current with regulations. This is a full-time, day-shift position with competitive compensation.