Utilization Review RN - Case Mgmt

Location: Beverly, MA
Job ID: 174471-1A
Date Posted: Apr 29, 2022
Category: Nursing

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Job Description

Welcome To

Welcome to Beverly Hospital, part of Beth Israel Lahey Health. Beverly Hospital is a full service, community hospital providing leading-edge, patient-centered care to North Shore and Cape Ann residents. The hospital provides a full-range of state-of-the-art care and services including primary care, cardiovascular care, surgery, orthopedics, emergency care, maternity, pediatrics, as well as many other specialties. Beverly Hospital is nationally recognized for patient safety as it is one of only 42 hospitals in the United States to be awarded an “A” grade from The Leapfrog Group – the nation’s leading nonprofit watchdog on hospital quality and safety.

 

Beverly Hospital 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 Community, Respect, Excellence, Accountability, Teamwork and Empathy.

 

About the Job

Job Description

 

 

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, days

About Us

Beth Israel Lahey Health is dedicated to improving health and wellness and making a difference in the lives of our patients, their families and all members of the communities we serve.  Formed in March 2019, Beth Israel Lahey Health is a patient-centered, integrated care delivery system providing a continuum of services spanning academic, tertiary and community hospitals, dedicated orthopedic and psychiatric hospitals, primary and specialty care, community acute care, ambulatory care, behavioral services and home health.  Beth Israel Lahey Health Performance Network is a unified joint contracting and population health management organization, jointly governed by participating physicians and hospitals.

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