Sr. Utilization Management Nurse - Field RN
$72.8k - $130kIntelliResume
About This Role The Sr. Utilization Management Nurse role focuses on ensuring the accuracy of medical record coding, supporting proper payment to nursing facilities, and promoting quality patient care in the Boston MA Regional Area. Highlights Location: Boston, MA Schedule: Full Time, Day shift Travel: At least 90% travel within the state of Massachusetts Work Style: Field-based Pay: $72,800 - $130,000 annually What You'll Do Audit entire medical record for accuracy of the coding on the MDS to support payment to the nursing facility Audit anti‑psychotic therapy for quality review Discuss patient care specifics with peers or providers Communicate clinical findings and present rationale for decisions to medical professionals and members Review the entire medical record for accuracy and appropriate clinical treatment Communicate findings of audits to client and community as needed Educate stakeholders about audit results and corrective plans Comply with HIPAA guidelines related to Personal Health Information (PHI) Leverage experience to review chart/clinical information and identify appropriate course of care Perform medical chart review to identify patients' needs Requirements Education: Must be a Registered Nurse (RN) with a current, active, unrestricted RN License in Massachusetts Experience: 4+ years of nursing experience in long-term care and/or medical record review Experience working within medical insurance and/or healthcare industries Licenses & Certifications: Current RN License in Massachusetts required Must currently have or be able to obtain an RAC/CT MDS certification #J-18808-Ljbffr
Vacancy posted 1 day ago
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