Utilization Review Specialist, per diem

Brigham and Women’s Hospital • Northampton, MA, United States • $200k - $250k / year • 1m ago

About Us

With energy and purpose, Cooley Dickinson Health Care, a member of the Mass General Brigham system, is advancing health care in western Massachusetts, and has been since 1886. Our network employs more than 2,000 medical professionals and support staff, at our main Hospital campus in Northampton and additional locations in twelve towns throughout the Pioneer Valley. Cooley Dickinson’s VNA & Hospice is also a vital part of our network, providing home-based services throughout Hampshire and Franklin counties.

Accolades and Recognition

Our staff has been consistently recognized for the quality of care and commitment to patient safety provided on a daily basis.Some of these awards include:

Centers for Medicare and Medicaid Services (CMS) 5-star rating
The American Association of Critical Care Nurses ( AACN ) Beacon Award for Excellence
Human Rights Campaign Foundation LGBTQ+ Healthcare Equality Leader designation
The American College of Emergency Physicians (ACEP) awarded a Level 3 Geriatric Emergency Department Accreditation (GEDA)
Baby-Friendly USA d esignated Baby-Friendly Hospital

The Utilization Review Specialist is responsible for using clinical best practice knowledge and skilled intervention to determine patient level of care and provide concurrent review with insurance payers in order to achieve quality outcomes and ensure appropriate reimbursement.

This position reports to the Director, Case Management, Social Work and Pastoral Care and operates within established organizational and departmental policies and procedures.

Graduate of an approved, accredited school of nursing required
RN licensure in the Commonwealth of Massachusetts required; BSN required or must be enrolled in BSN program or actively in pursuit of BSN
Case Management certification preferred
One (1) to three (3) years experience in either hospital or payer-based case management, discharge planning, utilization management, and/or reimbursement required
Strong knowledge of disease processes and clinical documentation skills required
Demonstrated knowledge of InterQual criteria required
Demonstrated excellent interpersonal, organizational, and communication skills as well as the ability to collaborate effectively with physicians and other members of the healthcare team
Demonstrated ability to orchestrate many activities and manage multiple priorities required
Demonstrated proficiency with personal computer required
Excellent vocabulary, grammar, spelling, punctuation, and composition skills proven through the development of written communication required

Graduate of an approved, accredited school of nursing required
RN licensure in the Commonwealth of Massachusetts required; BSN required or must be enrolled in BSN program or actively in pursuit of BSN
Case Management certification preferred
One (1) to three (3) years experience in either hospital or payer-based case management, discharge planning, utilization management, and/or reimbursement required
Strong knowledge of disease processes and clinical documentation skills required
Demonstrated knowledge of InterQual criteria required
Demonstrated excellent interpersonal, organizational, and communication skills as well as the ability to collaborate effectively with physicians and other members of the healthcare team
Demonstrated ability to orchestrate many activities and manage multiple priorities required
Demonstrated proficiency with personal computer required
Excellent vocabulary, grammar, spelling, punctuation, and composition skills proven through the development of written communication required

It is the policy of Cooley Dickinson Health Care to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Cooley Dickinson Health Care will provide reasonable accommodations for qualified individuals with disabilities.

Cooley Dickinson Health Care embraces diverse skills, perspectives and ideas, and encourages people of color, veterans, people with disabilities, LGBTQ candidates, and people from other underrepresented groups to apply.