RN Utilization Reviewer II - Per Diem

Site: Wentworth-Douglass Hospital

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.

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

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.

Additional Job Details (if applicable)

Physical Requirements• Standing Frequently (34-66%)

• Walking Frequently (34-66%)

• Sitting Occasionally (3-33%)

• Lifting Frequently (34-66%) 35lbs+ (w/assisted device)

• Carrying Frequently (34-66%) 20lbs - 35lbs

• Pushing Occasionally (3-33%)

• Pulling Occasionally (3-33%)

• Climbing Rarely (Less than 2%)

• Balancing Frequently (34-66%)

• Stooping Occasionally (3-33%)

• Kneeling Occasionally (3-33%)

• Crouching Occasionally (3-33%)

• Crawling Rarely (Less than 2%)

• Reaching Frequently (34-66%)

• Gross Manipulation (Handling) Frequently (34-66%)

• Fine Manipulation (Fingering) Frequently (34-66%)

• Feeling Constantly (67-100%)

• Foot Use Rarely (Less than 2%)

• Vision - Far Constantly (67-100%)

• Vision - Near Constantly (67-100%)

• Talking Constantly (67-100%)

• Hearing Constantly (67-100%)

Remote Type

Remote

Work Location

789 Central Avenue

Scheduled Weekly Hours

0

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range $58,656.00 - $142,448.80/Annual

Grade 98TEMP

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

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 Veteran’s 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.

Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” 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.