Utilization Review Nurse

2 weeks ago


Milford MA United States Milford Regional Medical Center Full time

Per 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 a nonprofit, acute-care facility, where more than 300 primary care and specialty physicians are committed to providing exceptional healthcare services to our community with dignity, compassion, and respect. Statement of Purpose:# The Utilization Review Nurse is responsible for utilization management at MRMC. The UR nurse performs reviews of current inpatient services and determines medical appropriateness of inpatient and observation services following evaluation of medical guidelines and benefit determination. #In addition, the UR Nurse will also manage the denial and appeal process under the guidance of the UR Manager. # Qualifications: Education:# Bachelor of Science in Nursing required Masters in Healthcare preferred Certification/License:# Massachusetts Registered Nurse licensure required Certified Case Manager, preferred Experience: # # Minimum of 5 years acute or critical care experience Minimum of 1 year Nurse Case Management experience Minimum of 1 year Utilization Review Nurse Experience including solid working knowledge with InterQual criteria #

Per 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 a nonprofit, acute-care facility, where more than 300 primary care and specialty physicians are committed to providing exceptional healthcare services to our community with dignity, compassion, and respect.

Statement of Purpose:

The Utilization Review Nurse is responsible for utilization management at MRMC. The UR nurse performs reviews of current inpatient services and determines medical appropriateness of inpatient and observation services following evaluation of medical guidelines and benefit determination. In addition, the UR Nurse will also manage the denial and appeal process under the guidance of the UR Manager.

Qualifications:

Education:

Bachelor of Science in Nursing required

Masters in Healthcare preferred

Certification/License:

Massachusetts Registered Nurse licensure required

Certified Case Manager, preferred

Experience:

Minimum of 5 years acute or critical care experience

Minimum of 1 year Nurse Case Management experience

Minimum of 1 year Utilization Review Nurse Experience including solid working knowledge with InterQual criteria



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