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Clinical Utilization Specialist, Per Diem

2 months ago

Northampton, Massachusetts, United States Mass General Brigham Full time
About the Role

As a Utilization Review Specialist with Mass General Brigham, you will play a critical role in ensuring the quality and efficiency of patient care. This position requires a strong understanding of clinical best practices and the ability to effectively communicate with insurance payers to achieve quality outcomes and ensure appropriate reimbursement.

Key Responsibilities
  • Conduct concurrent reviews with insurance payers to determine patient level of care
  • Use clinical best practice knowledge to provide skilled intervention and achieve quality outcomes
  • Collaborate with healthcare teams to ensure seamless patient care
  • Develop and maintain strong relationships with insurance payers to ensure timely and accurate reimbursement
Requirements
  • Graduate of an approved, accredited school of nursing
  • RN licensure in the Commonwealth of Massachusetts
  • BSN required or currently enrolled in BSN program
  • Case Management certification preferred
  • 1-3 years experience in hospital or payer-based case management, discharge planning, utilization management, and/or reimbursement
  • Strong knowledge of disease processes and clinical documentation skills
  • Demonstrated knowledge of InterQual criteria
  • Excellent interpersonal, organizational, and communication skills
  • Ability to collaborate effectively with physicians and other healthcare team members
What We Offer

Mass General Brigham is committed to providing a work environment that is inclusive, equitable, and respectful. We offer a competitive salary and benefits package, as well as opportunities for professional growth and development.