Peer To Peer Utilization Management Nurse Rn (32 Hours)

Mass General Brigham Incorporated

United States
Base: $58,656.00 - $142,448.80 annually; bonus/equ...
Fully remote
Bsn degree required
Active rn license
5+ years acute care nursing experience
The role serves as an integral member of the Central Utilization Management team specializing in identifying and reviewing cases for peer-to-peer engagement with payers

Job Summary

  • The role serves as an integral member of the Central Utilization Management team specializing in identifying and reviewing cases for peer-to-peer engagement with payers.
  • Candidates must apply nationally recognized criteria like InterQual and MCG to evaluate payer denials and determine the appropriateness of inpatient versus observation status.
  • This position offers a competitive annual salary range of $58,656.00 to $142,448.80 along with comprehensive benefits and career advancement opportunities.

Matching Summary

The role serves as an integral member of the Central Utilization Management team specializing in identifying and reviewing cases for peer-to-peer engagement with payers.

Salary

Base: $58,656.00 - $142,448.80 annually; Bonus/Equity: Not specified; Benefits: Comprehensive benefits, career advancement, differentials, premiums, bonuses, and recognition programs

Skills & Requirements

Must-have

  • BSN degree required
  • Active RN license
  • 5+ years acute care nursing experience
  • 3+ years utilization review experience
  • InterQual or MCG criteria expertise
  • EPIC electronic medical records proficiency

Nice-to-have

  • CPUR or CCM certification preferred
  • Experience with peer-to-peer discussions
  • Strong negotiation and collaboration skills
  • Denial trend analysis background
  • Autonomous work in high-volume environment

Key Requirements

  • Bachelor of Science in Nursing (BSN)
  • Valid RN license
  • 5+ years acute care hospital experience
  • 3+ years utilization management experience
  • 1+ year applying InterQual/MCG criteria
  • 1+ year managing payer denials

Work Rights

Not specified

Tailored Resume

Cover Letter