Governance & Risk Lead at Chain IQ responsible for S2C and P2P service delivery excellence. Collaborating closely with internal teams to manage risks and ensure quality compliance.
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Hybrid Nurse Manager, Utilization Review, Clinical Appeal Management
Posted 3 months ago
About the role
- Nurse Manager for Utilization Review and Clinical Appeal Management at Boston Medical Center. Overseeing operations and compliance while leading training and quality initiatives in healthcare.
Responsibilities
- 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
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