Utilization Review Case Manager Jobs in Boston, MA

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

This position is full time, day shifts, 40 hours per week (5 8-hour shifts). Weekend and holiday rotation required. This Case Manager position is intended to work with the inpatient floors at Lahey Clinic.
The inpatient Case Manager assigned by nursing unit coordinates utilization review, discharge planning and monitors quality assurance for Lahey Clinic inpatient admissions. Leads the multidisciplinary team to ensure a timely process.

Job Description:

Essential Duties & Responsibilities including but not limited to:

1) Performs utilization review and discharge planning to inpatient admissions.
2) Applies Interqual, AEP and or other review criteria approved by the Clinic to accurately determine appropriateness for inpatient and outpatient care.
3) Utilizes clinical expertise to determine the appropriate level of care for patients. Leads the healthcare team in selecting appropriate, safe, hospital or alternative care options.
4) Works closely with Community Case Managers to collaborate regarding medically fragile and or high risk patients admitted to the clinic.
5) Identifies delay days and notifies Team Leader.
6) Reports serious occurrences and sentinel events to Risk Management.
7) Works with patients and families to facilitate post hospital care and develop plans to meet short and long-term needs. 
8) Accurately manages observation status patients by working with physicians to ensure appropriate utilization.
9) Is part of the department’s Saturday, Sunday, holiday and beeper rotation as needed.
10) Supports all service line activities related to utilization and quality management.
11) Assists in the development and implementation of clinical pathways.
12) Adheres to all insurance, contractual and regulatory requirements as mandated.
13) Works with Lahey Clinic nursing, social work and other members of the healthcare team to coordinate and facilitate patient discharge.
14) Works with the Post Acute Care Coordinator to facilitate timely patient access to post acute care Services.
15) Participates in hospital or medical committees representing patient issues and department functions such as case management, utilization and CQI as requested.
16) Incorporates Lahey Clinic Guiding Principles , Mission Statement and Goals  into daily activities.
17) Complies with all Lahey Clinic Policies. 
18) Complies with behavioral expectations of the department and Lahey Clinic.
19) Maintains courteous and effective interactions with colleagues and patients.
20) Demonstrates an understanding of the job description, performance expectations, and competency assessment.
21) Demonstrates a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
22) Participates in departmental and/or interdepartmental quality improvement activities.
23) Participates in and successfully completes Mandatory Education.
17) Performs all other duties as needed or directed to meet the needs of the department.
Minimum Qualifications: 

Education: 
•     Registered Nurse, Bachelors Degree or commensurate experience preferred. 
 

Licensure, Certification, Registration:  
•    Must hold current Commonwealth of Massachusetts license as a Registered Nurse, and Basic Life Support (BLS)

Skills, Knowledge & Abilities: 
In the absence of any of these skills, demonstrates the ability to be thoroughly trained to Proven leadership and project management experience and skill meet organizational standards.
•    Effective verbal communication, problem solving and conflict resolution skills.
•    Basic computer and typing skills.
•    Basic knowledge of Quality Improvement techniques.
•    Demonstrated ability to organize and work independently

Experience:     
•     A minimum of three years of medical/surgical nursing care experience.  Two years of case management or utilization management experience desirable.
•    Demonstrated ability to communicate effectively with medical and hospital staffs.

Pay Range:

$38.11 - $98.23

The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law.  Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment. More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger. Equal Opportunity Employer/Veterans/Disabled