9 utilization review rn jobs found

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers. Partners with the health care team to ensure reimbursement of hospital admissions is based on medical necessity and documentation is sufficient to support the level of care being billed. Conducts concurrent reviews as directed in the hospital’s Utilization Review Plan and review of medical records to ensure criteria for admission and continued stay are met and documented. Along with other health care team members, monitors the use of hospital resources and identifies delays. Job Description: Essential Functions and Responsibilities: 1, Performs a variety of concurrent and retrospective utilization...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Under the general supervision of the ACNO of Inpatient Services & Staffing Office, The Patient Flow, Admissions & Discharge Registered Nurse (RN) is responsible for assessments and tasks associated with smooth patient care movement. The main function includes coordinating and completing patient admissions and discharges on designated patient care units as determined by the needs of the hospital. This role ensures a safe, efficient, and patient-centered transition into the inpatient setting by conducting comprehensive admission assessments, medication reconciliation, patient and family education, and other tasks related to supporting the patient and hospital unit workload. This role helps decrease the workload on bedside nurses, allowing them to focus more on direct patient care while supporting operational efficiency and patient flow. This aligns with the...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Under the general supervision of the ACNO of Inpatient Services & Staffing Office, The Patient Flow, Admissions & Discharge Registered Nurse (RN) is responsible for assessments and tasks associated with smooth patient care movement. The main function includes coordinating and completing patient admissions and discharges on designated patient care units as determined by the needs of the hospital. This role ensures a safe, efficient, and patient-centered transition into the inpatient setting by conducting comprehensive admission assessments, medication reconciliation, patient and family education, and other tasks related to supporting the patient and hospital unit workload. This role helps decrease the workload on bedside nurses, allowing them to focus more on direct patient care while supporting operational efficiency and patient flow. This aligns with the...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. The Medical Assistant provides clinical and administrative support to the Urology team to ensure safe, efficient, and high quality patient care. Responsibilities include rooming patients, obtaining vital signs and medical histories, preparing examination and procedure rooms, assisting providers during office based procedures including cystoscopies, vasectomies, prostate biopsies, and other urologic procedures, processing specimens, coordinating patient care, and completing clinical documentation. The Medical Assistant works collaboratively with physicians, advanced practice providers, nurses, and other team members to maintain efficient patient flow and deliver an excellent patient experience. This position requires flexibility to rotate between the Burlington and Peabody urology clinics based on operational and staffing needs. Job Description: Essential...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. The Director of Surgical Services provides 24/7 leadership and operational oversight for all surgical service areas, including the Operating Room, PACU, Endoscopy, Pre‑Admission Testing, Central Sterile Processing, scheduling, and inventory management. The position reports directly to the Chief Nursing Officer. This role ensures safe, efficient, and compliant patient care aligned with AORN, AAMI, TJC, and CMS standards. The Director collaborates with senior leadership, surgeons, anesthesiologists, and nursing teams to drive strategic planning, optimize block scheduling and billing practices, and achieve organizational goals related to quality, performance, productivity, and workforce engagement. Job Description: Lead Surgical Excellence at a Growing Community Hospital At Milton Hospital , we combine the personal touch of a community hospital...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. 40 hours per week; 9:00am-5:30pm or 9:30am-6:00pm; Rotate Every Third Weekend & Holidays Job Description: Job Summary: The RN Case Manager (CM) facilitates the coordination of care for those patients admitted to medical, surgical services, ICU, and as needed for outpatient areas including but not limited to the Emergency Department, PACU and Preadmission testing. The case manager consults and collaborates in activities related to the establishment of appropriate levels of care. He/She reviews patient's medical records and participates in direct and indirect communication with care givers to ensure continued appropriate level of acre, including the level of care of elective surgical cases. The case manager provides ongoing education to the physicians and nurses about levels of care. The RN Case manager, performs, consults, and collaborates in...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. The Medical Assistant supports the delivery of safe, high-quality, and empathetic care across ambulatory settings. Under the supervision of licensed providers or clinical overseers, the MA performs direct patient care, assists with clinical operations, and supports care coordination all while helping ensure a smooth and efficient daily workflow. Job Description: Essential Duties & Responsibilities  I.    Clinical Considerations and Decision Making: Ways in which the MA comes to understand the problems, issues or concerns of patients/families, to attend to relevant/critical information and to respond in concerned and involved ways.     A.    Accountable for providing safe patient care by demonstrating organizational skills that maintain and coordinate safe delivery of quality care for assigned patients/families.      B.    Participates in a culturally...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. The Utilization Analyst works with physicians, the payers and inpatient case management team to validate the medical necessity of the hospital care. Using the concepts of utilization review, clinical documentation improvement and revenue integrity, these specialized case managers analyze medical documentation to ensure that proper reimbursement will be achieved in coordination to the intensity of medical care provided. . Job Description: Essential Duties & Responsibilities including but not limited to:  1.    Completes initial reviews of patient records within 24–48 hours of admission:  evaluate documentation to evaluate medical necessity of the hospital care.  2.    Conducts follow-up reviews of patients daily in accordance with payer requirements.   3.    Speaks with Attending physicians regarding status determinations and/or supportive...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. WE CARE by fostering the wellbeing of a health-focused workplace that supports work-life balance, empathy in understanding others' perspectives, collaboration for extraordinary results, accountability to achieve collective goals, respect for diversity and inclusiveness, and equity by ensuring everyone has the opportunity to reach their full potential. Job Description: Case managers serve as the care coordinators for patients, care givers, and families. Their functions include concurrent and retrospective review to ensure appropriate utilization, assessment, prevention of denials, and coordination of discharge options. They are required to follow specific criteria sets to ensure regulatory compliance. They coordinate safe discharge plans between the health care delivery team, patients, families, insurers, and continuing care agencies....