Utilization Review Analyst - Registered Nurse (Per Diem) at Beth Israel Lahey Health Burlington,NC Job Burlington area,North Carolina

Job Title & Location

Utilization Review Analyst – Registered Nurse (Per Diem) – Burlington, NC

Job Summary

This is a per‑day position with a minimum commitment of 16 hours per month, ideally around five 8‑hour shifts monthly. Shifts are available during the day and on weekends. The role is on‑site at Lahey Hospital and Medical Center.

Responsibilities

Completes initial reviews of patient records within 24–48 hours of admission, evaluating documentation for medical necessity.

Conducts follow‑up reviews of patients daily in accordance with payer requirements.

Speaks with attending physicians regarding status determinations and/or supportive documentation.

Educates physicians and key healthcare providers about the importance of accurate and complete documentation and the correct level of care.

Collaborates with case managers, nursing staff, the coding team, physicians and finance on relevant issues.

Participates in the analysis and trending of statistical data for specified patient populations to identify improvement opportunities.

Reviews external (e.g., PEPPER) and internal data (e.g., outliers) to trend, track and educate to improve outcomes.

Assists with preparation and presentation of utilization review monitoring/trending reports for review with physicians and hospital leadership.

Educates members of the patient care team regarding specific documentation needs and reporting and reimbursement issues identified through daily and retrospective documentation reviews and aggregate data analysis.

Instructs staff on best practices to ensure reimbursement based on medical care provided.

Maintains and reports clinical documentation improvement results in a clear and concise manner to the medical, clinical, and management staff.

Applies diplomacy and professionalism when interacting with physicians and clinical staff, especially when addressing missing or conflicting medical record information.

Qualifications

Education:

Registered Nurse (RN) required;
Bachelor’s degree desirable.

Licensure / Certification: RN; RN with CDIP, CCM, ACM highly desirable.

Experience:

Minimum 5 years inpatient utilization review / case management experience.

Knowledge of payment methodologies, federal and state regulations, and strong communication skills required.

Compensation

Base hourly wage range: $38.11 – $98.23, depending on factors such as seniority, education, training, certifications, location, job responsibilities and applicable shift differentials. Additional pay may include overtime, premium pay and other practices in accordance with law.

Requirements

All staff must be vaccinated against influenza (flu) as a condition of employment.

EEO Statement

Equal Opportunity Employer / Veterans / Disabled.

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Utilization Review Analyst - Registered Nurse (Per Diem) at Beth Israel Lahey Health Burlington, NC