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Utilization Review Manager - Remote

Posted 6 days ago
Healthcare
Part Time
USA
$41.36 - $100.00/hour

Overview

The Utilization Review Manager plays a crucial role in managing patient care through effective utilization review and case management practices.

In Short

  • Perform utilization reviews to determine appropriate levels of care.
  • Collaborate with patients and interdisciplinary teams for discharge planning.
  • Manage referrals to post-acute care services.
  • Document interactions and maintain communication with third-party payers.
  • Monitor quality issues and facilitate necessary documentation.
  • Coordinate clinical denials and appeals processes.
  • Function independently in a fast-paced environment.
  • Utilize critical thinking and negotiation skills with insurance companies.
  • Ensure compliance with healthcare standards and regulations.
  • Provide compassionate care and support to patients and families.

Requirements

  • Bachelor's Degree in Nursing required.
  • MA Registered Nurse License required.
  • 3+ years of Utilization Review and Case Management experience preferred.
  • 5+ years of Acute Care Nursing experience preferred.
  • Basic computer skills and proficiency in Excel and Word.
  • Ability to interact within a diverse community.
  • Competence with InterQual Criteria and healthcare documentation.
  • Strong negotiation skills with third-party payers.
  • Ability to provide care despite patient challenges.
  • Proficient in ECare usage.

Benefits

  • Competitive base pay with comprehensive benefits.
  • Career advancement opportunities.
  • Recognition programs for contributions.
  • Support for professional growth.
  • Flexible working environment.

N.H

Newton-Wellesley Hospital

Newton-Wellesley Hospital, part of the Mass General Brigham system, is a not-for-profit healthcare organization dedicated to advancing patient care, research, teaching, and community service. With a commitment to diversity, equity, and inclusion, the hospital values a wide range of backgrounds and experiences, believing that this diversity strengthens their mission and drives innovation in medical research and patient care. As a leader in the practice of medicine with a rich history of over 200 years, Newton-Wellesley Hospital is focused on enhancing healthcare quality and value while fostering a passionate and welcoming community for both patients and staff.

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