RN Case Manager, Utilization Review, Case Management UM/UR (24 hrs) - Boston Children's Hospital

The Utilization Review Nurse will be responsible for:

• Completing Utilization Management Clinical Reviews including: reviewing hospital admissions and continued inpatient stays to assess appropriateness of level of care and duration of treatment plan, in accordance with established procedures, guidelines and criteria
• Focusing on high priority utilization review activity including: conducting emergency admission level of care assessments in real time
• Reviewing the observation census to align level of care assignments with CM assessment and physician’s orders 
• Assessing discharges for utilization review completion 
• Working in a fast paced, collaborative environment with multi-disciplinary team.
• Maintaining communication and collaboration among payer, providers, hospital departments and external agencies in order to promote continuity and coordination of care.
• Supporting the functions of the UM department as assigned
• Working 24 hours per week, day/evening 8 hour shifts M-F, as well as some weekends for covering the ED.

To qualify, you must have:

• MA RN license
• BSN required, MSN preferred
• 1 year at least of Case Management/UR experience preferred
• Case Management certification preferred
• 5 years acute nursing experience

Boston Children’s Hospital offers competitive compensation and unmatched benefits including flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.