Per Diem RN Case Manager, Utilization Management/Review

Department Summary: The UM Case Managers at Boston Children's review documentation within 1 business day of patient admission to assess for the appropriateness of an inpatient status, and regularly provide reports to insurers to update them on the plan for care of hospitalized patients. They work alongside Patient Financial Services staff, assisting with obtaining authorizations for the appropriate level of care for admissions and with post-discharge appeals of payer denials. They identify and implement initiatives to manage utilization trends, collaborating with the hospital's discharge planning case managers, healthcare team, and Patient Financial Services. They are part of an interdepartmental team that works to ensure appropriate patient access to services and efficient use of hospital resources. Key Responsibilities: Assessing, planning, organizing and overseeing daily clinical operations of care coordination and transitions to address the comprehensive and complex health needs of the patient and family. Possessing knowledge of community health services, payer systems and post-acute care needs for outpatient and inpatient patients and families. Collaborative work with clinic teams and inpatient case managers. Demonstrating the ability to integrate regulatory requirements, length of stay, resource allocation, funding sources, and capacity management to optimize delivery of appropriate services. Actively participating in departmental and multidisciplinary programs, committees and special projects. Working M-F days as needed (including up to 3 weekends per year) Minimum Qualifications Education: A Bachelor's degree in nursing. Master's in a related Healthcare field preferred. Experience: 5 years nursing experience required, pediatric experience preferred. Experience as a Case Manager (Discharge Planning and or Utilization Management) preferred. Licensure/ Certifications: Current Massachusetts license as a Registered Nurse (RN) A certification as a Certified Case Manager (or other pediatric specialty certification like CPN or CCRN) is preferred. 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.