Utilization Management RN

Utilization Management RN

Full‑time position at the Regional Office in Hopkinton, MA (Vital Core Health Strategies, an industry leader in Correctional Healthcare).

• Serve as a Regional Office Case Manager for an incarcerated population, advocating for optimum healthcare.
• Maintain accurate, detailed reports and confidential records.
• Consult and coordinate with healthcare team members to assess, plan, implement, or evaluate patient care plans.
• Modify patient treatment plans based on patient responses and clinical conditions.
• Review all aspects of facility patient care and off‑site referrals for appropriateness and resource utilization.
• Act as a liaison with off‑site providers (specialty and hospitals).
• Oversee hospitalized cases, reviewing daily clinicals and providing information to facility MD and team.
• Assist with hospital discharge planning to ensure goals of care are met.
• Seek infirmary‑level bed placement when higher level care is needed.
• Additional duties as assigned by the regional office.

• Graduate of an accredited School of Nursing.
• Licensure as a registered nurse in the state of employment with at least 1 year of experience, or as an LPN with at least 5 years of experience.
• Preferred experience in medical‑surgical, case management, and/or discharge planning.
• Active CPR certification.
• Knowledge of specific state laws and regulations governing practice.
• Successful completion of initial and annual clinical competencies as required by the role.

$100,000 – $110,000 per year.

• Holiday pay on major holidays (New Year’s, Martin Luther King Jr., Memorial, Juneteenth, Independence, Labor, Veteran’s, Thanksgiving, Christmas).
• Medical/Dental/Vision insurance
• Life insurance
• Short‑term/Long‑term disability
• Identity theft protection
• Animal/pet insurance
• Employee Assistance Program and discount center
• 401(k) plan
• EEO statement