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Per Diem RN Case Manager, Utilization Management/Review
Department Summary:The UM Case Managers at Boston Children's review documentation within 1 business day of patient admission to assess for the appropriateness of an inpatient status, and regularly provide reports to insurers to update them on the plan for care of hospitalized patients. They work alongside Patient Financial Services staff, assisting with obtaining authorizations for the appropriate level of care for admissions and with post-discharge appeals of payer denials. They identify and implement initiatives to manage utilization trends, collaborating with the hospital's discharge planning case managers, healthcare team, and Patient Financial Services. They are part of an interdepartmental team that works to en
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