Utilization Review RN

Baystate Health is Seeking Hospital Utilization Review RN

The Utilization Review RN is a registered professional nurse responsible for the coordination of care, quality and financial outcomes for a designated population of patients. The UR RN coordinates use of BH resources to assure that patients are provided optimal quality of care and service, researches and responds to all medical and behavioral health appeal inquiries and requests, in accordance with contractual, account, policy and accreditation requirements, conducts admission and concurrent reviews to obtain certification, facilitates and coordinates with internal and external customers in a proactive manner to bring review/appeal to satisfactory resolution, collaborates with payers through ongoing written and verbal communication to optimize the reimbursement potential for Baystate Franklin Medical Center, coordinates resolution of patient complaints regarding questionable and/or inappropriate charges, adheres to system and department compliance policies and any applicable laws and regulations and provides high quality customer service.

Schedule

Inpatient Unit - 40 hours - Every 3rd Weekend & Holiday

Required Work Experience:

• MA RN License required
• BSN preferred
• 3-5 years acute care clinical nursing experience or inpatient Case Management experience required
• Experience in utilization review process and utilization management strongly preferred

Benefits That Support You

At Baystate Health, you get the best of both worlds: the resources, stability, and career opportunities of a large integrated healthcare system with the supportive culture of a community-focused organization.

Depending on eligibility, benefits may include:

• Competitive Pay & Benefits: Medical, dental, and vision coverage, including local Health New England plans.
• Tuition & Training: Tuition assistance, CEUs, and professional development opportunities.
• Career Growth: Clinical advancement, leadership development, and internal career opportunities.
• Regional Opportunities: Career options across Baystate Health hospitals, practices, and services throughout western Massachusetts.
• Retirement: Retirement savings and employer match.
• Paid Time Off: Generous PTO for eligible employees.

Whether you provide direct patient care, clinical services, or operational support, your work at Baystate Health helps improve the health of the communities we serve.

Education:

Diploma in Nursing (Required)

Certifications:

Registered Nurse - State of Massachusetts

Compensation

Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries may vary by position and will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range. Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees.

Minimum - Midpoint - Maximum

$40.65 - $53.96 - $67.26

Equal Employment Opportunity Employer

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.