Responsible for the oversight of communication between the hospital and third party payors to ensure that care delivered in the hospital is reimbursed and that resource consumption is appropriate. Supervises the Utilization Management Office to ensure the timely communication of clinical information and to minimize clinical denials. Tracks, monitors and reports utilization data to the Utilization Management committee and Case Management leadership. Serves as a liaison between Case Management, Patient Financial Services and any other department where collaboration in the provision of services is required.
Graduate of an accredited baccalaureate nursing program required.
Licensed to practice professional nursing as a registered nurse in the Commonwealth of Massachusetts required.
Minimum of five (5) years of progressively responsible nursing experience. Relevant and recent clinical experience required.
Expereince with Care Management and Utilization Management require.
Previous leadership experience with demonstrated management ability preferred.
Interpersonal and communications skills sufficient to provide effective leadership for assigned staff and to interact effectively with patients, visitors, physicians, and a variety of health team members and hospital staff required.
Analytical abilities necessary to organize, supervise and evaluate the work of others.
Ability to develop, interpret, implement and evaluate policies, procedures, standards and budgets, and to utilize current nursing practice concepts and theories required.
Proficient with standard Microsoft programs (i.e. MS Word, Excel, PowerPoint, Outlook) and web browsers. Experience with or ability to learn standard hospital billing systems.
Boston Medical Center - 2 years ago