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RN Jobs in Woburn, MA

Utilization Management Nurse

$58,656 - $142,448.80 / year

Site: Mass General Brigham Health Plan Holding Company, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more. Given equity, this position will pay somewhere between $90,000 to $107,000 annually. At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience, if applicable, education, certifications, and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums, and bonuses as applicable, and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. Job Summary The UMCM will utilize clinical knowledge to analyze, assess, and render approval decisions, to determine the need for physician review as well as complete determinations following physician review. The ideal candidate will have prior authorization (outpatient review) experience in a managed care setting with commercial health plan knowledge. Principal Duties and Responsibilities: • Expertise in clinical review for prospective, concurrent, retrospective utilization management reviews utilizing Interqual ®, company policies and procedures, and other resources as determined by review, including physician reviews as needed for all lines of business as per departmental needs • Review authorization requests for medical services, including making initial eligibility and coverage determinations, screening for medical necessity appropriateness, determining if additional information is required, and referral to correct programs within Mass General Brigham Health Plan as needed. • Manage incoming requests for procedures and services including patient medical records and related clinical information. • Strong working knowledge of commercial, self-insured, fully insured and limited network plans. • Adherence to program, departmental and organizational performance metrics including productivity. • Excellent verbal and written communication skills. • Excellent problem solving and customer service skills. • Would need to be available for “on call” for a minimum of once per month with the possibility of that increasing depending on staff availability; Approximately 6 months after hire. • Must be self-directed and highly motivated with an ability to multi-task. • Develop and maintain effective working relationships with internal and external customers • Hold self and others accountable to meet commitments. • Sound decision-making and time management skills. • Proactive in areas of professional development, personally and for the department. • Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise. • Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization. • Proficient with Microsoft Word, Excel, Outlook, McKesson InterQual ®, Outlook, SharePoint, PC based operating system, and web-based phone system. Qualifications Education Associate's Degree Nursing required or Bachelor's Degree Nursing preferred Licenses and Credentials Massachusetts Registered Nurse (RN) license required Experience At least 2-3 years of utilization review experience is highly preferred Experience using Interqual or Milliman is highly preferred At least 1-2 years of experience in a payer setting is highly preferred At least 1-2 years of experience in an acute care setting is highly preferred Knowledge, Skills, and Abilities Demonstrate Mass General Brigham Health Plan’s core brand principles of always listening, challenging conventions, and providing value Strong aptitude for technology-based solutions. Embrace opportunities to take the complexity out of how we work and what we deliver. Listen to our constituents, learn, and act quickly in our ongoing pursuit of meaningful innovation Current in healthcare trends. Ability to inject energy, when and where it’s needed. Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback. Be accountable for delivering high-quality work. Act with a clear sense of ownership. Bring fresh ideas forward by actively listening to and working with employees and the people we serve. Communicate respectfully and professionally with colleagues Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback. Education Associate's Degree Nursing required or Bachelor's Degree Nursing preferred Licenses and Credentials Massachusetts Registered Nurse (RN) license required Experience At least 2-3 years of utilization review experience is highly preferred Experience using Interqual or Milliman is highly preferred At least 1-2 years of experience in a payer setting is highly preferred At least 1-2 years of experience in an acute care setting is highly preferred Knowledge, Skills, and Abilities Demonstrate Mass General Brigham Health Plan’s core brand principles of always listening, challenging conventions, and providing value Strong aptitude for technology-based solutions. Embrace opportunities to take the complexity out of how we work and what we deliver. Listen to our constituents, learn, and act quickly in our ongoing pursuit of meaningful innovation Current in healthcare trends. Ability to inject energy, when and where it’s needed. Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback. Be accountable for delivering high-quality work. Act with a clear sense of ownership. Bring fresh ideas forward by actively listening to and working with employees and the people we serve. Communicate respectfully and professionally with colleagues Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback. Additional Job Details (if applicable) Working Conditions Would need to be available for “on call” for a minimum of once per month with the possibility of that increasing depending on staff availability; Approximately 6 months after hire. This is a remote role with occasional onsite team meetings in Somerville, MA. Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $58,656.00 - $142,448.80/Annual Grade 98TEMP At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: 8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Part-time

6 days ago

Per diem RN cath lab

South Shore Health Weymouth, MA

$38.20 - $77.39 / hour

If you are an existing employee of South Shore Health then please apply through the internal career site. Requisition Number: R-22316 Facility: LOC0001 - 55 Fogg Road55 Fogg Road Weymouth, MA 02190 Department Name: SSH Cardiac Catheterization Status: Part time Budgeted Hours: 0 Shift: Varied Shifts (United States of America) Manages individualized, outcome oriented nursing care through the use of the nursing process. Provides care, treatment and services through the successful coordination and completion of a series of processes that include assessment, planning care, providing care, in accordance with departmental and hospital policies and procedures. Commits to working a minimum of 16 hours over two (2) shifts per 4 week schedule. Also works 1 day before or after a major summer or winter holiday. Compensation Pay Range: $38.20 - $77.39 Job Description 1. Medication Administration a. Demonstrates knowledge of and follows SSH policies and procedures for administering, transcribing, and recording medications. b. Completes medication reconciliation process following SSH policy and procedure. c. Demonstrates proper procedure for the documentation of narcotic withdrawal, administration, verifies count, wastes per policy and resolves narcotic discrepancy. 2. Plan of care/Documentation/Patient Family Centered Care/Patient Experience Develops, discusses, and communicates a prioritized problem list/plan of care for each patient. a. Develop, evaluate and update individualized plan of care for patient and documents outcomes. b. Initiating admission assessment within 8 hours of admissions, identifies and documents patient/family/significant other teaching needs upon admission and throughout hospitalization. c. Continues assessment/reassessment and identifies care needs within established nursing practice. d. Documents all patient care following the department of nursing policy, unit based standards, disease processes (CHF, PNA vaccines) and nurse sensitive indicators (falls, skin, CAUTI) e. Assess/reassesses and documents patient's level of comfort utilizing the appropriate pain scale and the patient's response to each intervention both pharmacological and non-pharmacological per South Shore Hospital policy. f. Works on behalf of patient /family. Seeks help to represent patient/family when they are unable to represent themselves. g. Raises ethical questions and concerns with clinical team. Seeks available resources to help formulate and understand ethical decisions. h. Actively communicates plan of day via white board updating every shift. i. Facilitates discharge/transfer by goal of 12:00pm, communicates barriers utilizing chain of command. 3. Safety/Quality - Foster's a "Culture of Safety" through personal ownership and commitment to a safe environment. a. Verifies patient identification with two identifiers prior to the start of any invasive procedure, including "time out", administration of care, medications, labeled specimen's an documents confirming the correct patient, procedure, site, equipment and consent. b. Complies with the current CDC hand hygiene guidelines through proper handwashing. Adheres to universal precautions, makes appropriate use of personal protective equipment at all times and appropriately disposes of hazardous materials. Maintains awareness of MSDS sheets and how to access. c. Ensures environment meets regulatory requirements at all times. d. Understands and is able to demonstrate individual roles and responsibilities in the event of hospital codes/emergency preparedness. 4. Professional Development: Assumes overall responsibility for own professional development by incorporating evidenced-based practice, research, and performance improvement initiatives as a part of ongoing nursing practice. a. Obtains at least 5 contact hours per year in area of practice. b. Practices within the legal boundaries of MA Nurse Practice Act. Directs other licenses and non-licensed personnel as assigned. c. Displays the ability to accept and respond appropriately to feedback and recommendations for change. d. Demonstrates professional working relationships with colleagues from all disciplines to promote a positive/encouraging workplace. e. Critical Thinking: analyzes causes of problems, identifies and evaluates alternative solutions, and selects appropriate solution, and communicates appropriately and effectively utilizing chain of command. f. Accountable for being informed about changes in hospital policy and procedure. 5. Technology: Utilizes technological solutions to work processes and practices. a. Access Lotus Notes to review email, learning management and other resources as applicable to RN role. b. Utilizes software applications required by department and unit standards. c. Accountable to understand how to operate in downtime. 6. Compliance a. Works within legal, regulatory and ethical standards relevant to the position. b. Complies with applicable policies and procedures. c. Safeguards the privacy and security of patient information. The employee compiles will policies and procedures relating to SSH’s privacy and security programs. d. Brings potential compliance issues to a manager, supervisor, director or VP. e. Complies with the mandatory education requirements of the compliance, privacy and security programs. 7. Patient and Family Centered Care a. Conveys respect for values, preferences, and expressed needs of the patient and family. b. Recognizes the patient, and family according to patient preferences, as important members of the health care team. c. Collaborates with the patient, and family according to patient preferences, in planning, implementing, and evaluating care. d. Welcomes the presence and participation of family members at all times according to patient preferences, regardless of rounds, change of shift, or other events on unit. 8. Age & Culture a. Possesses age and cultural knowledge and awareness. b. Considers the individual needs of each person with whom they interact. c. Interacts with sensitivity in the delivery of care/services of diverse populations as needed. d. Effectively utilizes resources to provide care/services - such as, interpreter services and on-line sources. Minimum Education - Preferred Graduate of an accredited School of Nursing Minimum Work Experience Previous Acute Care RN experience preferred Required Licenses/Certifications RN - Registered Nurse Depending on department Basic Life Support (BLS) Certification, Advanced Cardiac Life Support (ACLS) Certification, Emergency Response Training Certification, Neonatal Resuscitation Program (NRP) Certification, Pediatric Advanced Life Support (PALS), Trauma Nurse Core Course (TNCC), Trauma Care After Resuscitation (TCAR) Certification may be required Per diem including on call and weekends Responsibilities if Required: Education if Required: License/Registration/Certification Requirements: ACLS (AHA) Advanced Cardiac Life Support Certification - American Heart Association (AHA) (Including courses offered through SSH), Basic Life Support (BLS) Certification - American Heart Association (AHA) (Including courses offered through SSH), INSTRUCTOR- Advanced Cardiac Life Support (ACLS) - American Heart Association (AHA) (Including courses offered through SSH), INSTRUCTOR- Basic Life Support (BLS) - American Heart Association (AHA) (Including courses offered through SSH), Neonatal Resuscitation Program (NRP) Certification - American Heart Association (AHA) (Including courses offered through SSH), OB- Emergency Response Training (ERT) - SSH Education & Training, Pediatric Advanced Life Support (PALS) Certification - American Heart Association (AHA) (Including courses offered through SSH), RN-Registered Nurse - Board of Registration in Nursing (Massachusetts), Trauma Care After Resuscitation (TCAR) - TCAR Education Programs, Trauma Nurse Core Course (TNCC) - Emergency Nurses Association - (ENA)