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RN - Utilization Nurse

Company: Milford Regional Medical Center
Location: Milford
Posted on: June 12, 2021

Job Description:

Statement of Purpose: The Utilization Review Nurse is responsible for utilization management at MRMC. The UR nurse performs reviews of current inpatient services and determines medical appropriateness of inpatient and observation services following evaluation of medical guidelines and benefit determination. In addition, the UR Nurse will also manage the denial and appeal process under the guidance of the UR Manager. # Qualifications:# Education:## Bachelor of Science in Nursing required#Masters in Healthcare preferred # Certification / License:# Massachusetts Registered Nurse licensure required, #Certified Case Manager, preferred. # Experience:##Minimum of 5 years acute or critical care experience Minimum of 5 years Nurse Case Management experience Minimum of 3 years Utilization Review Nurse Experience#including solid working knowledge with InterQual criteria # # # MRMC Differentials: Hospital differentials are: $3.50 hourly for evenings, $4.75 hourly for nights, and $2.75 hourly for weekends.# All differentials are paid based per hospital policy. #

Statement of Purpose: The Utilization Review Nurse is responsible for utilization management at MRMC. The UR nurse performs reviews of current inpatient services and determines medical appropriateness of inpatient and observation services following evaluation of medical guidelines and benefit determination.

In addition, the UR Nurse will also manage the denial and appeal process under the guidance of the UR Manager.

Qualifications:

Education: Bachelor of Science in Nursing required Masters in Healthcare preferred

Certification / License: Massachusetts Registered Nurse licensure required, Certified Case Manager, preferred.

Experience: Minimum of 5 years acute or critical care experience

Minimum of 5 years Nurse Case Management experience

Minimum of 3 years Utilization Review Nurse Experience including solid working knowledge with InterQual criteria

MRMC Differentials:

Hospital differentials are: $3.50 hourly for evenings, $4.75 hourly for nights, and $2.75 hourly for weekends. All differentials are paid based per hospital policy.

Keywords: Milford Regional Medical Center, Worcester , RN - Utilization Nurse, Other , Milford, Massachusetts

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