Utilization Review Nurse (Grade 17) 2 Positions

Ensures that the Network Health member population receives timely concurrent reviews and interventions as established by Network Health's medical management department. Ensures efficient operation for the membership with ongoing evaluation and continuous improvement in processes and outcome. Responsible for concurrent review processes and interventions; reviews of acute and postacute facility level of care, and coordinates discharge plans for alternate levels of care, and available community resources. Collaborates with disease and program-specific case managers to determine program admission as appropriate. This position will also work directly with the manager of utilization and referral management to ensure appropriate levels of care for the Network Health provider network. Requirements

Conducts reviews of inpatient facilities via the telephone, for LOS and care coordination.Collaborates with all members of the clinical affairs department to meet Network Health's goals and objectives, while coordinating services for the member population.Communicates with all internal departments regarding issues related to length of stay and care coordination. Interacts with departments identifying variances for care coordination, and specific payment and level of care situations.Works with external providers to coordinate discharge plans.Communicates effectively with the associate medical director regarding identified variances or specific members according to criteria utilized to determine appropriate levels of care.Evaluates existing processes, identifies opportunities for improvement, and develops action plans when necessary.Coordinates delivery of services to members throughout the continuum of care and interfaces with appropriate providers to ensure the quality and availability of these services. Qualifications

R.N.Background in concurrent review/utilization management in acute managed care. Understanding of different alternative levels of care. Medicaid experience a plus. Computer experience. Flexibility. McKesson InterQual experience a plus. Willingness to be part of a fast-moving and exciting clinical development team. How to apply

Send your resume with a cover letter to careers@network-health.org . Please include the above Job Code in the subject line of your email. Or, mail them to:

Network Health
Attn: Human Resources
101 Station Landing
Fourth Floor
Medford, MA 02155