Job Description

The Utilization Review Nurse will be responsible for:
Completing Utilization Management Clinical Reviews including: reviewing hospital admissions and continued inpatient stays to assess appropriateness of level of care and duration of treatment plan, in accordance with established procedures, guidelines and criteria
Focusing on high priority utilization review activity including: conducting emergency admission level of care assessments in real time
Reviewing the observation census to align level of care assignments with CM assessment and physician’s orders
Assessing discharges for utilization review completion
Working in a fast paced, collaborative environment with multi-disciplinary team.
Maintaining communication and collaboration among payer, providers, hospital departments and external agencies in order to promote continuity and coordination of care.
Supporting the functions of the UM department as assigned
Working 40 hours per week: 8 hour shifts, Mondays - Fridays with some weekend obligation throughout the year. This is a hybrid role with primarily remote work but may need to be on campus at times. Must live within commuting distance of main hospital
To qualify, you must have:
MA RN license
BSN required, MSN preferred
1 year at least of Case Management/UR experience preferred
Case Management certification preferred
5 years acute nursing experience
Boston Children’s Hospital offers competitive compensation and unmatched benefits including flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.

Job Tags

Flexible hours, Shift work, Weekend work, Monday to Friday,

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Case Manager (RN), Utilization Management Job at Boston Children's Hospital, Boston, MA

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