Case Manager (RN), Utilization Management

Status

Full-Time

Standard Hours per Week

40

Job Posting Category

Nursing

Job Posting 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.

Office/Site Location

Boston

Regular, Temporary, Per Diem

Regular

Remote Eligibility

Onsite Only