Utilization Review Manager - Home Care jobs in Massachusetts

Job Description

Description

About Us

With energy and purpose, Cooley Dickinson Health Care, a member of the Mass General Brigham system, is advancing health care in western Massachusetts, and has been since 1886.

Our network employs more than 2,000 medical professionals and support staff, at our main Hospital campus in Northampton and additional locations in twelve towns throughout the Pioneer Valley.

Cooley Dickinson’s VNA & Hospice is also a vital part of our network, providing home-based services throughout Hampshire and Franklin counties.

Accolades and Recognition

Our staff has been consistently recognized for the quality of care and commitment to patient safety provided on a daily basis.

Some of these awards include :

• Centers for Medicare and Medicaid Services (CMS) 5-star rating
• The American Association of Critical Care Nurses (AACN) Beacon Award for Excellence
• Human Rights Campaign Foundation LGBTQ Healthcare Equality Leader designation
• The American College of Emergency Physicians (ACEP) awarded a Level 3 Geriatric Emergency Department Accreditation (GEDA)
• Baby-Friendly USA designated Baby-Friendly Hospital

The Utilization Review Specialist is responsible for using clinical best practice knowledge and skilled intervention to determine patient level of care and provide concurrent review with insurance payers in order to achieve quality outcomes and ensure appropriate reimbursement.

Qualifications

• Graduate of an approved, accredited school of nursing required
• RN licensure in the Commonwealth of Massachusetts required; BSN required or must be enrolled in BSN program or actively in pursuit of BSN
• Case Management certification preferred
• One (1) to three (3) years experience in either hospital or payer-based case management, discharge planning, utilization management, and / or reimbursement required
• Strong knowledge of disease processes and clinical documentation skills required
• Demonstrated knowledge of InterQual criteria required
• Demonstrated excellent interpersonal, organizational, and communication skills as well as the ability to collaborate effectively with physicians and other members of the healthcare team
• Demonstrated ability to orchestrate many activities and manage multiple priorities required
• Demonstrated proficiency with personal computer required
• Excellent vocabulary, grammar, spelling, punctuation, and composition skills proven through the development of written communication required

Last updated : 2024-06-07