Utilization Review/RN Case Manager - Full Time

Job Details

Description

The Utilization Review / Case Manager (UR / CM) monitors adherence to the hospital’s utilization review plan to ensure the effective and efficient use of hospital services.

The UR / CM RN will ensure that all patients admitted to Monadnock Community Hospital are appropriate for admission to the hospital and are at the correct level of care.

They will ensure that clinical reviews are given to the payer care manager in a timely manner and that potential denials in care are addressed concurrently to prevent retrospective denials.

This will involve communication and collaboration with payer care managers to understand their clinical criteria, appeal process and collaboration while patient is in house to prevent or minimize retrospective denials.

Assists in developing and implementing discharge plans appropriate to the individual patient’s needs as well as works with staff in coordinating care that utilizes the organizations resources efficiently and effectively.

In collaboration with physicians, nurses and other health care professionals, assess, plan, coordinate and oversee the plan of care for the in-patient population and effectively prepare patients for discharge through patient / family meetings and coordination of home services.

Provides guidance, consultation, education and training to the professional staff resulting in the provision of quality medical care in a cost effective and appropriate manner, while maintaining patient focus and meeting resulting outcomes.

This is a full time position. Will consider part time or job sharing.

About Our Benefits :

Amazing people deserve amazing benefits.

We strive to employ and retain the most highly qualified individuals by providing equitable wages and benefits, promoting from within, and supporting the continuing education efforts of our staff.

You will be valued and rewarded for the work you do here with excellent pay and outstanding benefits. At MCH, you’ll find great opportunities for career advancement as well as personal and professional growth.

Full-time employees enjoy :

• Health insurance
• Dental insurance
• Vision coverage
• Flexible spending accounts
• Life insurance
• Short and long-term disability insurance
• Accident and Critical Illness insurance
• Identity theft insurance
• Retirement savings plan
• Lifestyle spending account
• Free membership to local gym
• Generous paid time off plans
• Opportunities for professional development and training
• Positive work environment with a supportive team and opportunities for growth
• Scholarship Opportunities
• Tuition reimbursement

Apply Now! or click the Apply button above

About Monadnock Community Hospital :

Reach new heights at Monadnock Community Hospital.

MCH is a critical access hospital in beautiful, historic Peterborough, New Hampshire.

For 100 years, we have provided outstanding care to our communities, earning a reputation for excellence that has made us one of New Hampshire’s most successful and beloved small hospitals.

Join a culture of Compassion, Collaboration, Honesty, and Respect!

Our employees are the heart and soul of Monadnock Community Hospital.

In every department and at every level, MCH employees go above and beyond to deliver an exceptional patient experience in an atmosphere that is healthy, friendly, respectful, and personally fulfilling.

About the Monadnock Region :

A great place to live, work, and play.

One of the best things about working at Monadnock Community Hospital is that you get to live in a community that offers an amazing quality of life.

The state of New Hampshire consistently ranks in the Top Ten of all American states for its overall quality of life. Towns are small and friendly here, crime is low, schools are good, and the air and water are clean.

Balance meaningful work with a great life.

Here in the Monadnock Region, you can enjoy a standard of living that is hard to match anywhere. Let’s start with our mountain for which we are named.

Around the 3,165 foot Mount Monadnock with 100-mile views are forests, woods, lakes, and protected rivers providing abundant opportunities for hiking, biking, kayaking, fishing, cross-country skiing you name it!

And if you’re into the arts, the region also offers a lively arts scene, with galleries, theatres, and concert venues.

• New England community spirit
• Family-friendly
• Arts and culture
• All-season outdoor recreation
• Just 1.5 hours to Boston

Are you ready for a great job in a great place?

Are you ready for a career the supports your aspirations?

Are you ready to work in the best place you've ever lived?

Apply Now! or click the Apply button above

Our small hospital is committed to diversity, inclusion, and equal opportunity employment. We welcome applications from individuals of all backgrounds and abilities.

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, disability status, veteran status, or any other characteristic protected by law.

Qualifications

Skills

Required

Microsoft Excel

Intermediate

Behaviors

Motivations

Education

Preferred

Bachelors or better.

Experience

Required

Computer skills with demonstrated knowledge of Microsoft Office including Outlook and Excel. Minimum of five years acute care nursing experience, one year of case management, discharge planning and / or utilization review experience required.

Preferred

Knowledge of performance improvement principles, tools and techniques. Case Management certification required or willingness to obtain within two years.

Licenses & Certifications

Required

Registered Nurse