Medicare Utilization Management Nurse

You may choose to display a cookie banner on the external site. You must specify the message in the cookie banner and may add a link to a relevant policy. If you are unfamiliar with these requirements, please seek the advice of legal counsel. )* At least 2-3 years of utilization management strongly preferred* Experience applying National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and Medicare Benefit Policy Manual preferred* InterQual experience preferred* Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.* Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.* Ability to establish strong rapport and relationships with patients and staff.* Proficient in Microsoft Office and industry-related software programs.* Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.* Ability to maintain client and staff confidentiality.* **Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care.*** **Knowledge of Healthcare and Managed Care preferred.**Combat disease. Hold a hand. Help people. Impact the world.Mass General Brigham is a passionate, welcoming community where minds meet caring hearts.Our history includes New England hospitals founded over 200 years ago, some of the first and most prestigious hospitals in the world.Built on the legacy of two leading academic medical centers, we’re more than a system—we’re leaders in the practice of medicine. Mass General Brigham is committed to serving the community.We are dedicated to enhancing patient care, teaching and research, and taking a leadership role as an integrated health care system.We recognize that increasing value and continuously improving quality are essential to maintaining excellence. #J-18808-Ljbffr