Sr Utilization Management Nurse RN - Remote
Vetted Solutions · Boston, MA · Today
HealthcareFull-time
Key Responsibilities
- Audit medical records for coding accuracy and clinical appropriateness
- Review anti-psychotic therapy and overall patient treatment
- Collaborate with peers and providers to discuss care details
- Communicate audit findings and rationales clearly to medical professionals
- Educate stakeholders on audit results and corrective plans
- Ensure compliance with HIPAA and leverage clinical expertise for decision-making
- Perform comprehensive chart reviews considering patient conditions and social factors
- Apply knowledge of pharmacology and clinical protocols to assess care
- Work collaboratively within teams to identify appropriate actions and follow-up
- Travel within Massachusetts to conduct onsite audits as needed
Qualifications & Skills
- Active RN license in Massachusetts
- 4+ years nursing experience, especially in long-term care and medical record review
- Knowledge of Medicare, Medicaid, and healthcare industry processes
- Experience with coding, clinical audits, and healthcare regulations
- Proficiency in Microsoft Office
- Strong communication skills
- Reliable transportation and ability to travel extensively within the state
Pay
The role offers a competitive salary based on experience.
Schedule
The role offers remote work flexibility.
Benefits
The role includes benefits that emphasize improving health outcomes and ensuring compliance and quality in healthcare delivery.