- Signing Bonuses are paid out in three payments. You will receive your first payment (one third of the total amount) upon completion of the first 30 days of employment. You will receive the second payment upon completion of six (6) months and the third payment (final of the total amount) owe upon completion of one year following your start date. The bonus payments will be paid on the next regular pay day following the date on which you become eligible for the bonus. All payments are subject to applicable taxes.
- Signing Bonus is determined on a full-time status of 40 hours. Hours less than 40 hours will be prorated. Per Diem roles are not eligible.
- Current and former BILH candidates - restrictions apply. Employees within the BILH system are not eligible for the bonus or if you have been employed by a BILH entity within the last 12-months.
- If you leave Lahey Hospital & Medical Center before your first anniversary you will pay back the signing bonus.
- Please note, signing bonuses are subject to change based on the organization's hiring needs and will be determined by Talent Acquisition on an ongoing basis. BILH/LHMC Talent Acquisition reserves the right to change signing bonus eligible jobs and amounts at any time.
-
utilization review nurse
4 days ago
Beth Israel Lahey Health Burlington, MA , USA, United StatesWhen you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. · Job Type: · Regular · Scheduled Hours: · 8 · Work Shift: · Day (United States of America) · Lahey Hospital and Medical Center is now offering up to a $3,500 in signi ...
-
utilization review nurse
2 days ago
Beth Israel Lahey Health Burlington, MA , USA, United StatesJob Type: Regular · Time Type: Full time · Work Shift: Evening (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. · Job Type: · Regular · Scheduled Hours: · 40 · W ...
-
Claims Nurse Reviewer
1 day ago
BlueCross & BlueShield of Massachusetts Hingham, MA, United StatesThe Role. The Claims Nurse Reviewer is responsible for reviewing claims, validating coding and medical necessity of the services submitted and pricing the claims according to appropriate guidelines. This position requires strong clinical and medical Claims, Nurse, Registered Nurs ...
-
Nurse Reviewer, Endoscopy
6 days ago
Brigham & Women's Physicians Organization(BWPO) Braintree, United StatesUnder the direction of the Nurse Director of the BWPO's South Shore Endoscopy Center (SSEC), the Registered Nurse GI Case Reviewer will work as a critical member of the procedural care team to support the quality, efficiency and satisfaction of care taking place at the SSEC. The ...
-
utilization review nurse
4 days ago
Milford Regional Medical Center Milford, MA , USA, United StatesPer diem, 8a-4;30P as needed weekends + occ/ holidays About Us Milford Regional Medical Center is a full-service, community and regional teaching hospital located in Milford, Mass. and serves patients from more than 20 towns in Central Massachusetts. The 149-bed medical center is ...
-
claims nurse reviewer
3 days ago
BlueCross and BlueShield of Massachusetts Hingham, MA , USA, United StatesReady to help us transform healthcare? Bring your true colors to blue. · The Role · The Claims Nurse Reviewer is responsible for reviewing claims, validating coding and medical necessity of the services submitted and pricing the claims according to appropriate guidelines. This po ...
-
Claims Nurse Reviewer
1 week ago
Blue Cross Blue Shield of Massachusetts Hingham, United States Full timeThe Role · The Claims Nurse Reviewer is responsible for reviewing claims, validating coding and medical necessity of the services submitted and pricing the claims according to appropriate guidelines. This position requires strong clinical and medical coding skills to review claim ...
-
Utilization Review Nurse Manaer
3 days ago
Arrow Mutual Liability Insurance Newton, United StatesArrow Mutual Liability Insurance is seeking a talented individual for the position of UR Nurse Manager/UR nurse to determine the quality of care provided to injured workers including whether the medical services/procedures are appropriate and effective, performing Prospective, Co ...
-
Medical Assistant, 40hr
1 week ago
Winchester Hospital Woburn, United States Full timeJob Type: Regular · Time Type: Full 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. · Job Type: · RegularScheduled Hours: · 40Work Shift: ...
-
Operations Coordinator
5 days ago
New England Life Care Woburn, United StatesAt NELC we know that employees are looking for opportunities for advancement, flexible schedules, competitive wages, and a company culture that embraces you as a person, not just an employee. Come join our team regardless of your work history or level of experience The sky is the ...
-
Home Health Aide School Administrator
1 week ago
Best Home Care Wakefield, United States**FLEXIBLE MOTHERS HOURS** · ❖ Uses understanding based on empathetic listening and observation to influence, develop, help or lead others. · Essential Duties and Responsibilities: · ❖ Schedule training programs and instructors to teach classes. · ❖ Answer phones and provide the ...
-
Central Supply and Medical Records Clerk
1 day ago
Elderwood Wakefield, United States**Salary**: Pay: $ $22.39 / hour Overview: · **Central Supply and Medical Records Clerk Overview** · The Central Supply and Medical Records clerk is responsible for resident medical records and site medical equipment and supplies. The incumbent will inventory and order medical eq ...
-
Medical Assistant
3 days ago
Winchester Hospital Tewksbury, United StatesJob Type: Per Diem · 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. · The Medical Assistant provides high quality, direc ...
-
Nurse Practitioner
1 week ago
MRG Exams New Carlisle, United States Full timeWe are looking for the right Nurse Practitioner to perform medical assessments on United States Veterans as part of the VA's disability benefits process. · In performing Disability Assessments, you will review medical records electronically through a web portal and perform a focu ...
-
Nurse Practitioner
1 day ago
MRG Exams New Carlisle, United States Full timeWe are looking for the right Nurse Practitioner to perform medical assessments on United States Veterans as part of the VA's disability benefits process. · In performing Disability Assessments, you will review medical records electronically through a web portal and perform a focu ...
-
Oncology Nurse Navigator
5 days ago
Newton-Wellesley Hospital(NWH) Newton, United States**Oncology Nurse Navigator** · The Oncology Nurse Navigator is responsible for the day-to-day operations of the Cancer Center is responsible for maintaining and improving daily operations for oncology as a service line with interdisciplinary cancer team, to include coordinating a ...
-
Risk Adjustment Specialist
1 week ago
Atrius Health Newton, United States**Risk Adjustment Specialist** · Atrius Health is a nonprofit healthcare leader delivering a system of connected care that enables us to know our patients better so that we can serve them well. Across 32 clinical locations, more than 50 specialties and 825 physicians, we provide ...
-
Residential Rehab Assistant
3 days ago
The Carroll Center for the Blind Newton, United States**[JULY 1 - AUGUST 15, 2024; DAY, EVENING, OVERNIGHT AVAILABLE]** · *Overnight shifts include a single room during your shift, and time to sleep. · *training begins the last week of June · - Are you looking for a fun, exciting, and rewarding job this summer?_ · Consider spending ...
-
MRG Exams Watertown, United States Full timeWork can be performed by a Nurse Practitioner or Physician Assistant · We are looking for the right Nurse Practitioner or Physician Assistant to perform medical assessments on United States Veterans as part of the VA's disability benefits process. · In performing Disability Asses ...
-
Fresenius Medical Care Waltham, United States Full timePOSITION FEATURES:This position is part of the National Float Pool · Frequent overnight travel is required · Description · Provide your personal attention and kindness, professional insight, and a generosity of spirit. Offer expertise and encouragement. Enhance each patient's fut ...
utilization review nurse - Burlington, MA , USA, United States - Beth Israel Lahey Health
Description
When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.
Job Type:
Regular
Scheduled Hours:
40
Work Shift:
Evening (United States of America)
Lahey Hospital and Medical Center is now offering up to a $3,500 in signing bonuses for our Utilization Review positions.
Important Details:
To be eligible:
Job Description:
Job Description:
In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers.
Partners with the health care team to ensure reimbursement of hospital admissions is based on medical necessity and documentation is sufficient to support the level of care being billed.
Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria for admission and continued stay are met and documented.
Along with other health care team members, monitors the use of hospital resources and identifies delays.Essential Functions and Responsibilities:
Performs a variety of concurrent and retrospective utilization management-related reviews and functions to ensure that appropriate data are tracked, evaluated, and reported.
Works collaboratively with RN Case Managers to expedite patient discharge On-site in Burlington.
Maintains current knowledge of hospital utilization review processes and participates in the resolution of retrospective reimbursement issues, including appeals, third-party payer certification, and denied cases.
Monitors effectiveness/outcomes of the utilization management program, identifying and applying appropriate metrics, supporting the evaluation of the data, reporting results to various audiences, and implementing process improvement projects as needed.
Participates in analyzing, updating, and modifying procedures and processes to continually improve utilization review operations.
Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications, establishing personal networks; participating in professional societies.
Complies with federal, state, and local legal and certification requirements by studying existing and new legislation, anticipating future legislation; enforcing adherence to requirements; advising management on needed actions.
Performs other related duties as required and directed.
Qualifications:
Required
Licensure as a Registered Nurse (RN), Massachusetts
Three years of recent clinical or utilization management experience
Preferred:
Bachelor's degree in nursing or related healthcare fields.
Competence in standardized medical necessity criteria
Three years of recent case management or utilization management experience
ACM, CCM, or CMAC Certification
Knowledge, Skills, and Abilities:
Demonstrates expertise in the utilization management principles, methods, and tools and incorporates them into the daily operations of the organization.
Applies the principles and methods necessary to perform utilization management functions.
Competency in applying the principles, methods, materials, and equipment necessary in providing utilization management services.
Demonstrates clinical expertise to effectively facilitate the evaluation of the level of care required. Develops and maintain strong collaborative working relationships with physicians, nursing colleagues, and other clinical professionals.
Provide and receive feedback in a positive and constructive manner.
Ability to understand, interpret, and explain data for utilization management functions.
Demonstrates highly developed written, verbal, and presentation skills.
Possesses knowledge of care delivery systems across the continuum of care, including trends and issues in care reimbursement. Possesses mid to high-level proficiency in navigating the Electronic Medical Record and applications related to utilization management.
Compliance with the Code of Ethics and Guide for Professional Conduct.
FLSA Status:
Non-Exempt
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.
&v=024){kind=logo}
