[Hiring] RN Utilization Reviewer II @Mass General Brigham

Role Description

This is a per diem (as needed) position with M-F hours from 8:30 am - 5:00 pm, including weekend rotation. The position is remote.

Salary Range: $58,656.00 - $142,448.80, based on experience.

• Performs concurrent reviews of outpatient and in-patient claims and authorization reviews of patient services.
• Pursues receipt of high-quality medical outcomes for patients requiring precertification/preauthorization.
• Essential Functions:
• Assesses, reviews, and assigns cases for utilization review (UR).
• Assists with negotiations of access to care in specified targeted areas.
• Maintains relationships with providers who provide services to patients.
• Pursues a responsive system for authorization of services and approved claims.
• Assists 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; cautions others regarding potential breaches.
• Facilitates effective communication between members of the treatment team.

Qualifications

• Associates in Nursing degree required; BSN preferred.
• Registered Nurse [RN - State License].
• Clinical experience, including during training, working with Rehab and psychiatric in-patient population: 2-3 years required.
• 2 or more years of UR experience required.

Requirements

• 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.
• Ability to identify complex problems and review related information to develop and evaluate options and implement solutions.
• Work independently, be self-directed, and contribute as a member of a team.

Benefits

• Comprehensive benefits package.
• Career advancement opportunities.
• Differentials, premiums, and bonuses as applicable.
• Recognition programs designed to celebrate contributions and support professional growth.