Case Manager (RN), Utilization Management

Boston Children's Hospital
dental insurance, 403(b), remote work
United States, Massachusetts, Boston
Mar 05, 2025
Job Posting Description At Boston Children's Hospital, the quality of our care - and our inclusive hospital working environment - lies in the diversity of our people. With patients from local communities and 160 countries around the world, we're committed to reflecting the spectrum of their cultures, while opening doors of opportunity for our team. Here, different talents pursue common goals. Voices are heard and ideas are shared. Join us, and discover how your unique contributions can change lives. Yours included. The Utilization Review Nurse will be responsible for: Completing Utilization Management Clinical Reviews including: reviewing hospital admissions and continued inpatient stays to assess appropriateness of level of care and duration of treatment plan, in accordance with established procedures, guidelines and criteria Focusing on high priority utilization review activity including: conducting emergency admission level of care assessments in real time Reviewing the observation census to align level of care assignments with CM assessment and physician's orders Assessing discharges for utilization review completion Working in a fast paced, collaborative environment with multi-disciplinary team. Maintaining communication and collaboration among payer, providers, hospital departments and external agencies in order to promote continuity and coordination of care. Supporting the functions of the UM department as assigned Working 40 hours per week: 8 hour shifts, Mondays - Fridays with some weekend obligation throughout the year. This is a hybrid role with primarily remote work but may need to be on campus at times. Must live within commuting distance of main hospital To qualify, you must have: MA RN license BSN required, MSN preferred 1 year at least of Case Management/UR experience preferred Case Management certification preferred 5 years acute nursing experience Boston Children's Hospital offers competitive compensation and unmatched benefits including flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork. Boston Children's Hospital requires all employees to be vaccinated against COVID-19 and Flu, (unless you are eligible for a medical or religious exemption). Boston Children's Hospital is an Equal Opportunity / Affirmative Action Employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability.