RN Utilization Reviewer II - Per Diem
- Encompass
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Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
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Job Summary
M-F 8:30 am - 5:00 pm w/weekend rotation. This is a per diem (as needed position)Remote position
Salary Range: 58,656.00 - 142,448.80. Pay is based on experience.
Performs concurrent reviews of outpatient and in-patient claims and performs authorization reviews of patient services. Pursues receipt of high-quality medical outcomes for patients who require precertification/preauthorization. Does this position require Patient Care? Essential Functions: Assesses, reviews, and assigns cases for utilization review (UR).
Assists with the negotiations of access to care in specified targeted areas; maintains relationships with providers who provide services to patients and pursues a responsive system for authorization of services and approved claims.
-Assist with negotiating reimbursement rates with third party payers
-Prepares clinical information for each concurrent review directly from the medical record.
-Protects healthcare organization value by keeping information confidential; cautioning others regarding potential breaches.
-Facilitate effective communication between members of the treatment team
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Qualifications
Education
Associates in Nursing degree required. BSN preferred
Can this role accept experience in lieu of a degree?
No
Registered Nurse [RN - State License]
Experience
clinical experience, including during training, working with Rehab, psychiatric in-patient population 2-3 years required. 2 or more years of UR experience required
Knowledge, Skills and Abilities
- Broad knowledge of various insurances and government reimbursements.
- Excellent analytical and management skills.
- Strong written and oral communication skills.
- Familiarity with the utilization review process preferred.
- Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
- Broad knowledge of various insurances and government reimbursements is desirable.
- Work independently, be self-directed and contribute as a member of a team.
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Additional Job Details (if applicable)
Physical Requirements
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Remote Type
Remote
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Work Location
789 Central Avenue
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Scheduled Weekly Hours
0
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Employee Type
Regular
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Work Shift
Day (United States of America)
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Pay Range
$58,656.00 - $142,448.80/Annual
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Grade
98TEMP
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EEO Statement:
1810 Wentworth-Douglass Hospital is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteranās Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.
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Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership ālooks likeā by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
RN Utilization Reviewer II - Per Diem Ā· Massgeneralbrigham