Nurse Manager, Utilization Review, Clinical Appeal Management
Boston Medical Center (BMC)
full-time
Posted on:
Location Type: Hybrid
Location: Boston • Massachusetts • 🇺🇸 United States
Visit company websiteSalary
💰 $72,500 - $105,000 per year
Job Level
Mid-LevelSenior
About the role
- Overseeing the daily operations of the Utilization Management (UM) and Clinical Appeal teams
- Ensuring compliance with hospital policies, regulatory requirements, and payer guidelines
- Supporting efficient and effective utilization review and denial management processes
- Leadership, staff training, and quality improvement initiatives
- Collaborating with interdisciplinary teams to reduce payer denials
- Approving timekeeping and schedule changes in Kronos
- Providing comprehensive training for new staff and ongoing educational support for existing team members
- Conducting performance improvement audits
Requirements
- Nursing degree: Diploma, ASN or BSN (preferred)
- Ability to obtain BSN within 4 years
- Master’s Degree in Nursing or healthcare related field preferred
- Licensed to practice as a Registered Nurse in Massachusetts required
- CCM or related certification attained within 24 months from hire date preferred
- Minimum of 5 years of inpatient clinical nursing experience
- Minimum of 3 years of utilization review and denials management experience
- Epic and InterQual experience required
- ACM-RN or CCM preferred
- UKG Payroll experience preferred
- Experience working with vulnerable patient populations
- Clinical experience working with patients with multiple complex health issues
- Progressive leadership experience
Benefits
- Medical, dental, and vision insurance
- Discretionary annual bonuses and merit increases
- Flexible Spending Accounts
- 403(b) savings matches
- Paid time off
- Career advancement opportunities
- Resources to support employee and family well-being
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
utilization reviewdenial managementinpatient clinical nursingclinical experienceperformance improvement auditsstaff trainingquality improvement
Soft skills
leadershipcollaborationeducational support
Certifications
Registered NurseCCMACM-RN