Nurse Reviewer II

3 days ago

Shrewsbury, United States UMass Chan Medical School Full time
Job DescriptionPosition Summary

FOR MA POSITIONS:

Under the general supervision of the Associate Director, or designee, the Nurse Reviewer II is responsible for assessing clinical eligibility, prior authorizations and providing interval case consultation by reviewing medical records, assessing the clients needs, and providing resource support for program participants/applicants. This position ensures that eligible individuals are referred to and receive appropriate services based on medical necessity determinations and program/waiver regulations.

For Nh Positions

Under the general supervision of the Associate Director, or designee, the Nurse Reviewer II is responsible for assessing clinical eligibility, including nursing facility level of care determinations and pre-admission screening resident reviews by conducting face to face evaluation and reviewing nursing facility medical records. This position ensures that eligible individuals are referred to and receive appropriate services based on medical necessity determinations and program regulations. This position is based in New Hampshire.

Essential Functions

  • Contribute as an active member of a multi/inter-disciplinary team to assess, plan, organize, review and evaluate clinical eligibility.
  • Conduct on-site reviews and reassessments of applicant/participant/informal supports ability to assist with providing care when determining the medical necessity and clinical eligibility for assigned program and health care services.
  • Where applicable, determine and authorize services for applicants/participants in accordance with program guidelines and regulations.
  • Review and document all relevant information into data system applications in accordance with program guidelines and regulations.
  • Conduct routine and ad-hoc evaluations and re-evaluations of applicants/participants services.
  • Contact providers, state agency offices, and applicants/participants to obtain information and records needed to conduct a comprehensive clinical review of the case and final determination.
  • Review and document all relevant information into data system applications in accordance with program guidelines and regulations.
  • Maintain individual records documenting all applicant/participant encounters and contacts; write clinical summaries.
  • Prepare and respond to requests for statistics and resource/service data.
  • Foster and promote continuity of care and cooperative partnerships by liaising with health care providers, acute care hospitals, long term care facilities and other programs/organizations involved in the provision of services.
  • Participate in public relations efforts, attending conferences and meetings as needed.
  • Maintain positive working relationships with applicant/participants, and relevant informal supports, provider organizations, program consultants and state agencies.
  • Maintain the confidentiality of all business documents and correspondence per UMass Chan Medical School/ForHealth Consulting procedures and HIPAA regulations.
  • Participate in performance improvement initiatives and demonstrates the use of quality improvement in daily operations.
  • Comply with established departmental policies, procedures and objectives.
  • Comply with all health, safety and program regulations and requirements.
  • Perform other duties as required.

Required Qualifications

  • Bachelors degree in Nursing or equivalent experience
  • RN with current licensure to practice in state of program operations (NH or MA)
  • 5-7 years of related work experience
  • Knowledge of applicable state regulations
  • Ability to travel statewide
  • Experience with Office Application and database

Preferred Qualifications

  • Experience with disabled or long term care populations
  • Qualified Intellectual Disabilities Professional (QIDP) or Qualified Mental Health Professional (QMHP)
  • Experience in one of the following areas: Long-Term Care, Home Care, Rehab, Brain Injury, Mental Health, Substance Abuse and/or Disabilities.

Location - Need to be in proximity to Southeast Cape Cod Area

As an equal opportunity and affirmative action employer, UMass Chan recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds.

  • Nurse Reviewer II

    4 weeks ago

    Shrewsbury, United States UMass Chan Medical School Full time

    Job DescriptionPosition SummaryFOR MA POSITIONS:Under the general supervision of the Associate Director, or designee, the Nurse Reviewer II is responsible for assessing clinical eligibility, prior authorizations and providing interval case consultation by reviewing medical records, assessing the clients needs, and providing resource support for program...

  • Nurse Reviewer II-Eligibility

    2 months ago

    Shrewsbury, United States UMass Chan Medical School Full time

    Job DescriptionPosition SummaryFOR MA POSITIONS:Under the general supervision of the Associate Director, or designee, the Nurse Reviewer II is responsible for assessing clinical eligibility, prior authorizations and providing interval case consultation by reviewing medical records, assessing the clients needs, and providing resource support for program...

  • Nurse Reviewer II

    4 weeks ago

    Shrewsbury, MA, United States UMass Chan Medical School Full time

    Job DescriptionPosition SummaryFOR MA POSITIONS:Under the general supervision of the Associate Director, or designee, the Nurse Reviewer II is responsible for assessing clinical eligibility, prior authorizations and providing interval case consultation by reviewing medical records, assessing the clients needs, and providing resource support for program...

  • Nurse Rev II-Case Management

    4 days ago

    Shrewsbury, United States UMass Chan Medical School Full time

    Job DescriptionPosition SummaryUnder the general supervision of the Associate Director, or designee, the Nurse Reviewer II is responsible for providing administrative case management as part of the Community Case Management Program. This position is responsible for the authorization, coordination and facilitation of community long term care services for...

  • Consultant Pharmacist II

    6 months ago

    Shrewsbury, United States University of Massachusetts Full time

    Overview POSITION SUMMARY: Under the general direction of the Manager or Consultant Pharmacist Team Lead or designee, the Consultant Pharmacist II functions as a team member of the drug utilization review programs within Clinical Pharmacy Services (CPS). CPS is responsible for administering client-specific programs to provide clinical expertise in...

  • Medical Laboratory Scientist II Blood Bank FT Rotating

    4 days ago

    Shrewsbury, Massachusetts, United States MetroWest Medical Center Full time

    Job SummaryWe are seeking a highly skilled Medical Laboratory Scientist II to join our team at MetroWest Medical Center. As a key member of our laboratory team, you will be responsible for processing and testing various laboratory specimens, reviewing and reporting lab results, and performing operational duties, maintenance, and troubleshooting of laboratory...

  • Clinical Nurse

    2 months ago

    Shrewsbury, United States Shields Health Care Group Full time

    About our Ambulatory Surgery Centers: With a legacy deeply rooted in outpatient imaging, Shields built upon this expertise, diversifying our healthcare portfolio to include ambulatory surgical services. 35+ years of success in healthcare has earned Shields Ambulatory Surgery Centers (Shields ASC) a leading position in the surgery center industry. Through...

  • Clinical Nurse

    1 month ago

    Shrewsbury, United States Shields Health Full time

    About our Ambulatory Surgery Centers:With a legacy deeply rooted in outpatient imaging, Shields built upon this expertise, diversifying our healthcare portfolio to include ambulatory surgical services. 35+ years of success in healthcare has earned Shields Ambulatory Surgery Centers (Shields ASC) a leading position in the surgery center industry.Through...

  • Payroll Compliance Specialist

    2 weeks ago

    Shrewsbury, Massachusetts, United States UMass President's Office Full time

    Job Summary:The University's Employee Services Specialist II plays a pivotal role in ensuring compliance with federal, state, and local tax laws and regulations. This includes setup, auditing, analysis, and addressing payroll-related tax inquiries.Key Responsibilities:Maintain employee records and documentation related to payroll tax transactions, adhering...

  • Registered Nurse

    4 weeks ago

    Shrewsbury, United States Veterans Inc. Full time

    With the belief that they were there when we needed them, so we must be there now that they need us, Veterans Inc., the largest provider of supportive services to Veterans and their families in New England, is seeking to fill the Registered Nurse position and become a valued member of Veterans Inc. team!This position is responsible for conducting nursing and...

  • 2nd Shift Nursing/LPN

    3 months ago

    shrewsbury, United States IntelyCare Full time

    Make up to $53 an hour as a Licensed Practical Nurse (LPN) in Shrewsbury, Massachusetts, and neighboring towns, with the freedom to choose the shifts at partner facilities that fit your life the best. IntelyCare was founded by nurses who understand that nursing professionals with a real work-life balance provide the best patient care. Take your career to new...

  • Home Care Nurse For Worcester Areas

    4 months ago

    Shrewsbury, United States Guardian Angel Senior Services Full time

    "Guardian Angel Senior Services employ people with heart, patience, and understanding. We truly pride ourselves in the remarkable people that make up our staff. They are the ones responsible for creating the compassionate and caring environment that our clients receive." WORK FOR A COMPANY THAT CARES! Guardian Angel is celebrating our 21st anniversary! We...

  • Licensed Practical Nurse

    3 months ago

    shrewsbury, United States IntelyCare Full time

    Make up to $53 an hour as a Licensed Practical Nurse (LPN) in Shrewsbury, Massachusetts, and neighboring towns, with the freedom to choose the shifts at partner facilities that fit your life the best. IntelyCare was founded by nurses who understand that nursing professionals with a real work-life balance provide the best patient care. We also provide the...

  • Licensed Practical Nurse

    4 weeks ago

    shrewsbury, United States IntelyCare Full time

    Make up to $53 an hour as a Licensed Practical Nurse (LPN) in Shrewsbury, Massachusetts, and neighboring towns, with the freedom to choose the shifts at partner facilities that fit your life the best. IntelyCare was founded by nurses who understand that nursing professionals with a real work-life balance provide the best patient care. We also provide the...

  • Licensed Practical Nurse

    3 months ago

    shrewsbury, United States IntelyCare Full time

    Make up to $53 an hour as a Licensed Practical Nurse (LPN) in Shrewsbury, Massachusetts, and neighboring towns, with the freedom to choose the shifts at partner facilities that fit your life the best. IntelyCare was founded by nurses who understand that nursing professionals with a real work-life balance provide the best patient care. We also provide the...

  • Licensed Practical Nurse

    3 months ago

    shrewsbury, United States IntelyCare Full time

    Make up to $53 an hour as a Licensed Practical Nurse (LPN) in Shrewsbury, Massachusetts, and neighboring towns, with the freedom to choose the shifts at partner facilities that fit your life the best. IntelyCare was founded by nurses who understand that nursing professionals with a real work-life balance provide the best patient care. We also provide the...

  • Senior Living Health Care Professional

    1 week ago

    Shrewsbury, Massachusetts, United States LCB Senior Living, LLC Full time

    Job OverviewWe are seeking a dedicated and compassionate Licensed Practical Nurse (LPN) or Registered Nurse (RN) to join our team at The Residence at Orchard Grove. As a key member of our Resident Care Team, you will be responsible for providing high-quality care to our residents, working closely with the Resident Care Director to ensure the highest level of...

  • LPN / RN - The Residence at Orchard Grove

    2 weeks ago

    Shrewsbury, United States LCB Senior Living, LLC Full time

    Job DetailsJob Location The Residence at Orchard Grove - Shrewsbury, MA Position Type Full Time DescriptionIf you have been looking for a career that loves you back... This is the one!LCB Senior Living is hiring LPNs at The Residence at Orchard Grove. Apply today for immediate consideration!**Full-Time: Monday- Friday 9am- 5pm****Per Diem: 7am-3pm****New...