Utilization Review Charge RN - Case Management

Location: Beverly, MA
Job ID: 155906-1A
Date Posted: Aug 14, 2019

Job Description

Welcome To

Beverly Hospital  is part of a vibrant and growing health care system, recognized as a trailblazer in medicine and a standard bearer in patient experience. It includes an award-winning academic medical center, a superb constellation of community hospitals, home care services, rehabilitation facilities and more.

We are committed to attracting, developing and retaining top talent in a market long recognized and revered as a global leader in health. With a team approach to care, we encourage learning and growth at all levels, and we offer competitive salaries and benefits. We adhere to the principles of a just and fair work environment for all colleagues, where respect is foundational and performance is rewarded.

About the Job

Beverly Hospital, A member of Lahey Health, promotes the culture and philosophy which enables employees to give and receive the best of care.  You can become a part of the team that achieves this success through our CREATE values of Compassion, Respect, Excellence, Accountability, Teamwork, and Empathy. 

Position Summary:

The Utilization Management Nurse promotes the documentation of medical necessity and resource consumption during an inpatient hospitalization.  Performs medical necessity surveillance, conducts concurrent clinical reviews, manages patient status and integrates financial with clinical to ensure proper reimbursement.
Initiates provider concurrent and retrospective queries as supported by medical record documentation to improve the accuracy, integrity and quality of patient data, and improve the quality of the physician documentation within the body of the medical record.  Collaborates with the floor-based case managers, denials and appeals case managers, physician groups, staff nurses, coding staff and inter-professional team members.  Provides ongoing education to all inter-professional team members.

Scheduled Hours

40 hours per week, day shift.  Weekend & holiday rotation as per the needs of the department.  Service Charge role

About Us

The Lahey Model of Care—right care, right time, right place—is exactly what patients, providers and payers need and deserve. Identifying and delivering on this convergence of interests has positioned Lahey Health for further growth. Our model ensures care is highly coordinated and locally delivered, with lower costs and exceptional quality.

Lahey Health is a robust, regional system including a teaching hospital, community hospitals, primary care providers, specialists, behavioral and home health services, skilled nursing and rehabilitation facilities, and senior care resources throughout northeastern Massachusetts and southern New Hampshire. The system has a global presence with programs in Canada, Jordan and Bermuda.

Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.

Qualifications

 

Education/Experience:

Bachelor's degree in Nursing desirable

Case Management experience highly desirable.

Must have at least 5 years acute medical surgical nursing experience and/or an RN or other
healthcare with utilization review or clinical documentation improvement experience.

Knowledge of payment methodologies

                 License/Certification:

                 Current Massachusetts State Registered Nursing License