Regulatory Nurse Specialist
Baystate Health
full-time
Posted on:
Location Type: Remote
Location: Connecticut • Massachusetts • United States
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Salary
💰 $96,137 - $130,728 per year
About the role
- Delivering medical or behavioral health utilization management (UM) and coordination of care services to members
- Supporting the HNE mission by developing partnerships with and providing personal and accountable service to members and providers
- Managing all requirements around coding review for the department
- Ensuring that HNE operates within the policies, procedures, and regulations set forth by HNE and by state and federal laws
- Performing pre-authorization review utilizing criteria to determine appropriateness of requested services
- Assisting members and providers with transition of care, referral management, care coordination, and benefit management
- Developing and coordinating general compliance educational activities as directed by the Compliance Department
Requirements
- Massachusetts RN license required
- 3-5 years’ experience as a UM Clinical Review Nurse for a Health Plan
- Understanding of the use of medical coding
- Strong critical thinking skills
- Innovative thinker
- Strong analytical and research skills
Benefits
- Excellent Compensation
- High-quality, low-cost medical, dental and vision insurance
- Generous PTO
- Continuing education support and reimbursement
- Wellbeing programs that include but are not limited to mental, physical, and financial health
- Pet, home, auto and personal insurance
- Life insurance
- Reimbursement for a variety of wellbeing activities, included but limited to gym membership and equipment, personal trainer, massage and so much more!
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
medical codingutilization managementpre-authorization reviewcare coordinationreferral managementbenefit managementcompliance education
Soft skills
critical thinkinganalytical skillsresearch skillsinnovative thinking
Certifications
Massachusetts RN license