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- Tasks: Lead a team in managing healthcare reviews and appeals while ensuring compliance.
- Company: Beth Israel Deaconess Hospital-Plymouth is a leading healthcare provider focused on patient care.
- Benefits: Enjoy full-time employment with opportunities for professional growth and development.
- Why this job: Join a dynamic team making a real impact in healthcare transitions and patient outcomes.
- Qualifications: Must be a licensed RN in Massachusetts with 3 years of acute care experience.
- Other info: Vaccination against influenza and COVID-19 is required for this role.
The predicted salary is between 36000 - 60000 £ per year.
Manager of Utilization Review & Denials Management and Utilization Review Nurses
Join to apply for the Manager of Utilization Review & Denials Management and Utilization Review Nurses role at Beth Israel Deaconess Hospital-Plymouth.
Position Overview: Beth Israel Deaconess Hospital-Plymouth is expanding its Care Transitions Department and seeking experienced professionals. The RN – Utilization Review role involves managing concurrent reviews, appealing clinical denials, supporting accurate level-of-care determinations, and collaborating with healthcare teams. The Manager oversees daily operations, directs staff, maintains databases, analyzes denial trends, and participates in committees.
Responsibilities include:
- Conducting concurrent and retrospective reviews
- Leading appeals and peer-to-peer reviews
- Collecting data and analyzing denial trends
- Supporting discharge planning and compliance with regulations
- Engaging with stakeholders for education and prevention strategies
Qualifications:
- Current RN license in Massachusetts
- Minimum 3 years recent acute care experience
- Case management or utilization review experience within last 3 years
- Proficiency in InterQual
- Preferred or in-progress CCM, ACM, or other case management certification
Additional Details: The role requires vaccination against influenza and COVID-19. Seniority level is Mid-Senior, full-time employment, within the Hospitals and Health Care industry.
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Manager of Utilization Review & Denials Management and Utilization Review Nurses employer: Beth Israel Deaconess Hospital-Plymouth
Contact Detail:
Beth Israel Deaconess Hospital-Plymouth Recruiting Team
StudySmarter Expert Advice 🤫
We think this is how you could land Manager of Utilization Review & Denials Management and Utilization Review Nurses
✨Tip Number 1
Network with professionals in the healthcare industry, especially those who work in Utilization Review or Denials Management. Attend relevant conferences or workshops to meet potential colleagues and learn more about the role.
✨Tip Number 2
Familiarise yourself with the latest trends and regulations in Utilization Review and Denials Management. This knowledge will not only help you in interviews but also demonstrate your commitment to staying updated in the field.
✨Tip Number 3
Prepare to discuss specific examples from your past experience that highlight your skills in managing concurrent reviews and appealing clinical denials. Use the STAR method (Situation, Task, Action, Result) to structure your responses.
✨Tip Number 4
Research Beth Israel Deaconess Hospital-Plymouth and understand their Care Transitions Department. Tailor your conversation during interviews to reflect how your values align with theirs and how you can contribute to their goals.
We think you need these skills to ace Manager of Utilization Review & Denials Management and Utilization Review Nurses
Some tips for your application 🫡
Understand the Role: Before applying, make sure to thoroughly understand the responsibilities of the Manager of Utilization Review & Denials Management. Familiarise yourself with the key tasks such as conducting concurrent reviews and leading appeals.
Tailor Your CV: Highlight your relevant experience in acute care and any case management or utilization review roles. Make sure to include specific examples that demonstrate your proficiency in InterQual and any certifications you hold.
Craft a Compelling Cover Letter: Write a cover letter that not only outlines your qualifications but also expresses your passion for improving patient care and managing denial trends. Mention how your skills align with the goals of Beth Israel Deaconess Hospital-Plymouth.
Proofread Your Application: Before submitting, carefully proofread your CV and cover letter for any errors. A polished application reflects your attention to detail, which is crucial for the role you are applying for.
How to prepare for a job interview at Beth Israel Deaconess Hospital-Plymouth
✨Showcase Your Clinical Expertise
Make sure to highlight your clinical experience, especially in acute care and utilisation review. Be prepared to discuss specific cases where you successfully managed concurrent reviews or appealed clinical denials.
✨Demonstrate Leadership Skills
As a manager, you'll need to lead a team effectively. Share examples of how you've directed staff or improved operations in previous roles. Discuss your approach to mentoring and supporting your team.
✨Familiarise Yourself with Denial Trends
Research common denial trends in the healthcare industry and be ready to discuss how you would analyse and address these issues. Showing that you understand the data will impress your interviewers.
✨Engage with Stakeholders
Prepare to talk about your experience working with various stakeholders, including healthcare teams and regulatory bodies. Highlight any strategies you've implemented for education and prevention related to compliance.
