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- Tasks: Review patient admissions and collaborate with teams to optimise care and reimbursement.
- Company: Join the compassionate team at Beth Israel Deaconess Hospital-Plymouth.
- Benefits: Part-time hours, flexible shifts, and a chance to make a real difference.
- Why this job: Use your nursing skills to impact lives and improve healthcare outcomes.
- Qualifications: Current MA RN licensure and experience in utilization management required.
- Other info: Be part of a diverse team dedicated to patient care and community health.
The predicted salary is between 36000 - 60000 £ per year.
Join to apply for the REGISTERED NURSE - Utilization Review role at Beth Israel Deaconess Hospital-Plymouth.
Job Type: Regular
Time Type: Part time
Work Shift: Day (United States of America)
FLSA Status: Non-Exempt
When you join the growing BILH team, you’re not just taking a job, you’re making a difference in people’s lives.
32 hpw; 8-hr shifts (7a-3:30p flex); rotating weekends and holidays
Job Description:
Duties/Responsibilities:
- Reviews admission data to establish the appropriate level of care using Interqual criteria.
- Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient.
- Conducts concurrent reviews to determine the continued need for acute care setting, appropriateness and timeliness of treatments/procedures and to optimize the potential for reimbursement.
- Collaborates with the multidisciplinary team to assess and improve the denial management, documentation, and appeals process.
- Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established guidelines for admission or continued stay.
- Acts as a liaison between physicians and payers, coordinating peer-to-peer phone calls.
- Collects and compiles data as required.
It is understood that this is a summary of key job functions and does not include every detail of the job that may reasonably be required.
Education/Experience Required:
- Current MA RN licensure
- Bachelor’s Degree in Nursing or advanced degree in healthcare preferred.
- Three years recent, broad clinical experience in the hospital setting.
- Experience with utilization management within the last 3 years required.
- An understanding of the severity of an array of illnesses, intensity of service, and care coordination needs.
- Ability to identify appropriateness of patients' admission and level of care needs (inpatient & observation) utilizing Interqual criteria.
- Knowledge of Interqual required; Allscripts preferred.
- Strong interpersonal and negotiation skills demonstrated by a positive attitude, pleasant, professional and cooperative demeanor with patients, physicians, colleagues and insurance companies.
- Knowledge of government and insurance company reimbursement policies in regards to admission criteria, treatment and length of stay.
- Ability to work independently.
Registration/Certification:
- Current MA RN licensure.
As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment.
More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.
Equal Opportunity Employer/Veterans/Disabled.
REGISTERED NURSE - Utilization Review 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 REGISTERED NURSE - Utilization Review
✨Tip Number 1
Network like a pro! Reach out to your connections in the healthcare field, especially those who work at Beth Israel Deaconess Hospital-Plymouth. A friendly chat can open doors and give you insider info about the role.
✨Tip Number 2
Prepare for the interview by brushing up on your knowledge of Interqual criteria and utilisation management. We want you to shine, so practice answering questions related to clinical denials and care coordination.
✨Tip Number 3
Show off your interpersonal skills! During interviews, demonstrate how you collaborate with multidisciplinary teams and handle negotiations with insurance companies. Your positive attitude can set you apart from other candidates.
✨Tip Number 4
Don’t forget to apply through our website! It’s the best way to ensure your application gets noticed. Plus, it shows you’re serious about joining the BILH team and making a difference in patients' lives.
We think you need these skills to ace REGISTERED NURSE - Utilization Review
Some tips for your application 🫡
Tailor Your CV: Make sure your CV is tailored to the Registered Nurse - Utilization Review role. Highlight your relevant experience, especially in utilization management and clinical settings. We want to see how your skills match what we're looking for!
Craft a Compelling Cover Letter: Your cover letter is your chance to shine! Use it to explain why you're passionate about this role and how your background makes you a great fit. We love seeing genuine enthusiasm for making a difference in patients' lives.
Showcase Your Skills: Don’t forget to showcase your interpersonal and negotiation skills in your application. We value a positive attitude and cooperative demeanour, so let us know how you've demonstrated these traits in your previous roles.
Apply Through Our Website: We encourage you to apply through our website for the best chance of getting noticed. It’s super easy, and you’ll be part of the growing BILH team in no time. Let’s make a difference together!
How to prepare for a job interview at Beth Israel Deaconess Hospital-Plymouth
✨Know Your Stuff
Make sure you brush up on your clinical knowledge and the Interqual criteria. Be ready to discuss how you've used these in your previous roles, especially in relation to admission data and care coordination.
✨Showcase Your Experience
Highlight your three years of clinical experience and any specific instances where you've successfully navigated utilization management. Use examples that demonstrate your understanding of patient needs and the importance of appropriate care levels.
✨Be a Team Player
Since collaboration is key in this role, prepare to talk about how you've worked with multidisciplinary teams in the past. Share examples of how you’ve improved processes or resolved conflicts, especially in relation to denial management.
✨Stay Professional and Positive
Your interpersonal skills are crucial, so maintain a pleasant and professional demeanor throughout the interview. Practice active listening and be ready to engage in discussions about negotiation with physicians and payers.
