Utilization Review Nurse - Per-Diem

Utilization Review Nurse

At Merrimack Health, we are committed to pay transparency and equity. The base salary range is $37.50 to $76.34 hourly, excluding fringe benefits and potential bonuses. Your final base salary will be determined based on your education, experience, licensure, and internal equity considerations. Offers are typically made below the top of the range to support future salary growth.

The Utilization Review Nurse is responsible for determining the appropriateness of hospital admission, utilization of resources and medical necessity for continued stay. The URN is responsible for working with the Clinical Care Coordinator and Complex Care Manager to facilitate timely discharge, assure medical documentation accurately reflects the patient's severity of illness; and ensures compliance with the conditions of participation as they relate to Utilization Review and Discharge planning and payer regulations.

This specific position is based in the Emergency Center and works 1 shift per week 9pm 9am. Schedule will vary and include weekdays and weekend shifts. Current hospital MNA members eligible to apply.

• Utilizing Interqual Level of Care Criteria, ensures appropriate service assignment (inpatient vs observation) and collaborates with attending MD to reduce possibility of reimbursement denials
• Provides clinical information necessary for authorization to 3rd parties within one business day of request
• Communicates excess day and/or denial information to the team; resolves delays by negotiating with the team, ancillary services, 3rd parties
• Rounds with the care team and collaborates with the team to identify patient/families with complex discharge needs. Determines appropriate referrals.
• Ensures patients are discharged appropriately to alternative sites in a timely manner

Qualifications:

• BSN required; Master's degree preferred
• Current Massachusetts Nursing license
• Minimum 5 years clinical nursing experience
• 5 years case management experience in an acute care setting with discharge planning, continuing care, care management, and utilization review preferred.
• Strong verbal and written communications skills
• Proficiency with computers and an ability to learn new programs with ease.

Merrimack Health is a private, non-profit community hospital providing the Merrimack Valley & southern New Hampshire regions with patient-centered, compassionate, and quality health care for the whole family. For over 140 years, the dedicated doctors, nurses, and staff of Merrimack Health have been committed to improving the health of the people and communities we serve. We offer competitive pay, a robust benefit package, generous paid time off and free parking! We are an Equal Opportunity Employer committed to hiring a diverse workforce.

In 2022, Healthgrades ranked MH in the top 5 percent of hospitals in the country, and was awarded a top spot on Forbes' annual list of America's Best-In-State Employers 2020!