Lahey Health Utilization Review RN - Case Mgmt. in Beverly, Massachusetts
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
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.
40 hours per week, day shift.
Beth Israel Lahey Health is an integrated system providing patients with better care wherever they are. Care informed by world-class research and education. We are doctors and nurses, technicians and social workers, innovators and educators, and so many others. All with a shared vision for what healthcare can and should be. We are committed to attracting, developing and retaining top talent. We strive to create a diverse and inclusive workplace that reflects the communities in which we work and serve. With a team approach to care, we encourage learning and growth at all levels and offer competitive salaries and benefits.
Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.
Education/Experience:Bachelor's degree in Nursing desirableCase Management experience highly desirable.Must have at least 5 years acute medical surgical nursing experience and/or an RN or other healthcare with utilzation review or clinical documentation improvement experience.Knowledge of payment methodologies
License/Certification: Current Massachusetts State Registered Nursing License
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