Travel Nurse RN - Utilization Review

Job Description Mass General Brigham - Internal Travel is seeking a travel nurse RN Utilization Review for a travel nursing job in Boston, Massachusetts. Job Description & Requirements Specialty: Utilization Review Discipline: RN Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel Primary Location: Mass General Brigham Job Registered Nurse Organization Mass General Brigham Schedule Full-time, Remote Employee Status Temporary Mass General Brigham is looking for Registered Nurses to join our Internal Resource Pool (IRP). The IRP will allow RNs flexibility in scheduling short- or long-term assignments within our Mass General Brigham Hospitals at a premium rate of pay. All positions will be placed in inpatient or long term care units. Click here to learn more about our program: Internal Resource Pool . This is an exciting opportunity for Nurses that are: Seeking flexible schedule or work/life balance Interested in temporary work but not interested in traveling Want work flexibility; the ability to find the schedule that works for you Looking for opportunities to work on different types of units and hospitals within our system or a foot in the door to a long-term career General summary/ overview statement: The clinical nurse is a licensed registered nurse who is responsible for assuring competent, compassionate, individualized, nursing care for specific patients and families, including delegation to and supervision of non-professional clinical and support staff. The clinical nurse is responsible and accountable for the overall nursing care management of a designated group of patients. They collaborate with the Nursing Director and members of the Patient Care Team to achieve efficient patient outcomes. They also collaborate with the patient toward meeting the needs and expectations of the patient and family. Clinical nurses ensure that care is safe, efficient, effective, timely and meets the cultural, spiritual, and ethnic needs of each patient and family. PRINCIPAL DUTIES AND RESPONSIBILITIES: In order of importance, list essential areas of responsibility, major job duties, special projects and key objectives for this position. These items should be evaluated throughout the year and included in the written annual evaluation. This section should be completed as a bulleted list and explain how the role is performed.  Maintains strict adherence and maintains professional competency by keeping abreast of Medicare, MassHealth, and third-party payers regulatory and compliance requirements  Documents in the medical record as appropriate, as part of the Interdisciplinary team in accordance with the MGH Case Management Documentation standards  Utilize a translator when appropriate and incorporate awareness of patient’s cultural needs that may impact the plan of care  Monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused and friendly, high quality, efficient, and cost effective  In collaboration with multidisciplinary team, monitors the patient’s progress and plan of care with the aid of internal and external utilization and quality guidelines. Identifies, documents, and reports issues and system barriers  Complies with Case Management Standards of Practice, based on assignment  Evaluates, coordinates, manages and documents all activities related to clinical approval/denial processes and communicates relevant information to patients/families, members of the multidisciplinary team, hospital departments, and payers  Performs appropriate Level of Care (LOC) determinations based on severity of illness and intensity of service using InterQual® Criteria (IQ) (observation, inpatient, PPR)  Monitors appropriate length of stay and ensures patient needs are met while collaborating with payers to facilitate next LOC if appropriate  Monitors appropriate length of stay with consideration for patient safety and in consultation with the treating team.  Monitors and tracks potentially avoidable days  Collaborates with team to ensure patient benefits are adhered to and are within the scope of coverage for planning patient needs at discharge  Communicates with Patient Financial Services (PFS) to assist and support patients with insurance coverage  Coverage on weekends and holidays as per the Case Management policy  Performs other duties as assigned LICENSES, CERTIFICATIONS, and/or REGISTRATIONS (if applicable): Current licensure as a Registered Nurse in the Commonwealth of Massachusetts. Specialty certification preferred. SKILLS & COMPETENCIES REQUIRED: This section should be a bulleted list of minimum requirements explaining the skills (what the individual is trained for) and competencies (measurable as defined by the job) necessary to perform the job.  Acute hospital experience preferred  Strong assessment and problem-solving skills  Strong interpersonal skills  Ability to work independently with minimal supervision  Goal oriented and accountable  Demonstrated organizational skills  Demonstrated ability to work in a complex setting  Ability to work in an interdisciplinary team based environment  Strong oral and written communication skills  CM Certification preferred  Computer experience preferred LICENSES, CERTIFICATIONS, and/or REGISTRATIONS: Education: Minimum 2 years of RN experience Utilization Management experience required. Graduation from an accredited nursing program. EDUCATION: Minimum Required: 1 Some college or Associate’s Degree Preferred: 1 Bachelor’s Degree Mass General Brigham - Internal Travel Job ID 3269423-2R. About Mass General Brigham - Internal Travel As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women’s Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research. We’re passionate about a people-first culture for our system’s patients and our professional family. That’s why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees’ personal aspirations with projects that match their capabilities and crafting a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development—and we recognize success at every step. Our employees use the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Partnership & Collaboration. Mass General Brigham is looking for Registered Nurses to join our Internal Resource Pool (IRP). The IRP will allow RNs flexibility in scheduling short—or long-term assignments within our Mass General Brigham Hospitals at a premium rate of pay. All positions will be placed in inpatient or long-term care units. Benefits Weekly pay Holiday Pay 403b retirement plan Company provided housing options Sick pay Mileage reimbursement Discount program

Location: Boston, GA, US

Posted Date: 6/27/2025