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Certification Details Current Massachusetts Registered Nurse License Job Details Minimum Education BSN preferred Minimum Work Experience Previous UR/QA experience required 2 years of healthcare experience within the Acute Care, SNF, HHA, Behavioral Health, and/or Insurance Industry preferred Proficient computer skills required Must have effective written, verbal and interpersonal communication skills Excellent critical thinking Ability to multitask and flexibility essential Discharge planning experience as it pertains to the care transitions, referral process, patient preference/choice services, patient & family satisfaction, post-discharge follow-up etc. Job Requirements Current Massachusetts Registered Nurse License Interqual experience or equivalent preferred Meditech Expanse experience preferred Schedule Information Exerts 20 to 50 pounds of force occasionally, and/or up to 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects. Unit Specific Information Utilization Management- Utilization Review and Care Transitions & Coordination Multidisciplinary Team Rounds-participates in discharge planning rounds daily Quality & Statistical Data: Reviews medical record for abnormal findings, complications, delays, and deviations Denials/Appeal Process: Completes assessment of denial within 1 week providing supporting documentation Discharge Planning: Completes discharge planning assessments timely, efficiently and completely following regulatory standards
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