Nurse Rev II-Case Management
4 days ago
Under 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 program Members. As a member of a multidisciplinary team, the Nurse Reviewer II is responsible for assessing, planning, organizing, reviewing and evaluating the care needs of Members requiring community based services. This position fosters and promotes continuity of care and cooperative partnerships by liaising with nursing providers, state agency staff, acute care hospitals and other programs/organizations involved in the provision of services.
Essential Functions
- Serve as the clinical manager for an assigned caseload of Members.
- Contribute as an active member of a multi/inter-disciplinary team to assess, plan, organize, review and evaluate the care needs of Members requiring health care services, to include outpatient and home based therapy services.
- Conduct on-site reviews and assessments of Members community long term care needs to determine medical necessity and clinical eligibility for Community Case Management and Continuous Skilled Nursing Services Determine and authorize services for Members in accordance with program guidelines and regulations.
- Prepare and implement Member service records.
- Coordinate, facilitate and monitor the delivery of services to members.
- 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 Members services.
- Contact and engage providers, state agency offices, and Members to obtain information and records needed to conduct a comprehensive clinical review of the case and final determination.
- Evaluate and document the appropriateness of Members services and make modifications, as required.
- Maintain individual records documenting all Member encounters and contacts; write clinical summaries.
- Foster and promote continuity of care and cooperative partnerships by liaising with health care providers, acute care hospitals and other programs/organizations involved in the provision of services.
- Maintain positive working relationships with Members, relevant informal supports, provider organizations, 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.
- Perform other duties as required.
- RN licensed to practice in Massachusetts
- 5-7 years of work experience with at least 3 recent years providing direct service or case management to pediatric patients or young adults with special needs
- Ability to travel statewide to Member homes and service providers places of business
- Experience with Office Application and database
- Experience with home care
- Knowledge of applicable state regulations
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.
-
Consultant Pharmacist II
6 months ago
Shrewsbury, United States University of Massachusetts Full timeOverview 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...
-
Nurse Reviewer II
4 weeks ago
Shrewsbury, United States UMass Chan Medical School Full timeJob 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
3 days ago
Shrewsbury, United States UMass Chan Medical School Full timeJob 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 timeJob 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...
-
Registered Nurse Case Manager- BH
2 months ago
Shrewsbury, United States Elara Caring Full timeAt Elara Caring, we have a unique opportunity to play a huge role in the growth of an entire home care industry. Here, each employee has the chance to make a real difference by carrying out our mission every day. Join our elite team of healthcare professionals, providing the Right Care, at the Right Time, in the Right Place. Job Description: At Elara Caring,...
-
shrewsbury, United States DispatchHealth Management Full timeAdvanced Practice Provider APP at DispatchHealth Management summary: As an Advanced Practice Provider (APP) at DispatchHealth, you'll leverage your expertise as a Nurse Practitioner or Physician Assistant to deliver acute care directly in patients' homes. You will conduct comprehensive health assessments, perform various therapeutic interventions, and...
-
shrewsbury, United States DispatchHealth Management Full timeHow You'll Make an Impact: We are hiring Nurse Practitioners and Physician Assistants with acute care experience in ER, Urgent Care, or Internal Medicine to join our growing team serving the Worcester, MA community. Our Advanced Practice Providers team with DHMTs (Medical Technicians) and are equipped with everything needed to treat common to complex...
-
shrewsbury, United States DispatchHealth Management Full timeHow You'll Make an Impact: We are hiring Nurse Practitioners and Physician Assistants with acute care experience in ER, Urgent Care, or Internal Medicine to join our growing team serving the Worcester, MA community. Our Advanced Practice Providers team with DHMTs (Medical Technicians) and are equipped with everything needed to treat common to complex...
-
Nurse Reviewer II
4 weeks ago
Shrewsbury, MA, United States UMass Chan Medical School Full timeJob 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...
-
Mobile Healthcare Professional
1 week ago
Shrewsbury, Massachusetts, United States DispatchHealth Management Full timeAbout the RoleDispatchHealth Management is seeking a skilled Mobile Healthcare Professional to join our team in Worcester, MA. As an Advanced Practice Provider (APP), you will leverage your expertise to deliver acute care directly in patients' homes, conducting comprehensive health assessments and performing various therapeutic interventions.Key...
-
Shrewsbury, Massachusetts, United States DispatchHealth Management Full timeWe are a leading provider-led organization redefining healthcare delivery through mobile and virtual healthcare. Our team is comprised of experienced professionals with a passion for transforming the healthcare landscape.Our skilled, certified providers arrive onsite with the expertise and tools necessary to administer advanced medical care, supported by our...
-
Advanced Practice Provider APP
3 weeks ago
Shrewsbury, United States DispatchHealth Management Full timeHow You'll Make an Impact: We are hiring Nurse Practitioners and Physician Assistants with acute care experience in ER, Urgent Care, or Internal Medicine to join our growing team serving the Worcester, MA community. Our Advanced Practice Providers team with DHMTs (Medical Technicians) and are equipped with everything needed to treat common to complex...
-
Advanced Practice Provider, Hospital Medicine
4 weeks ago
Shrewsbury, United States DispatchHealth Management Full timeHow You'll Make an Impact: We are hiring Nurse Practitioners and Physician Assistants with acute care experience in ER, Urgent Care, or Internal Medicine to join our growing team serving the Worcester, MA community. Our Advanced Practice Providers team with DHMTs (Medical Technicians) and are equipped with everything needed to treat common to complex...
-
Acute Care Specialist
1 week ago
Shrewsbury, Missouri, United States DispatchHealth Management Full timeWe are seeking a skilled Acute Care Specialist to join our team at DispatchHealth in Worcester, MA. As an Advanced Practice Provider (APP), you will have the opportunity to deliver high-quality, compassionate care directly to patients' homes.About the RoleAs an APP with DispatchHealth, you will be part of a dynamic clinical care team that includes a...
-
Advanced Practice Provider APP
2 months ago
shrewsbury, United States DispatchHealth Management Full timeHow You'll Make an Impact: We are hiring Nurse Practitioners and Physician Assistants with acute care experience in ER, Urgent Care, or Internal Medicine to join our growing team serving the Worcester, MA community. Our Advanced Practice Providers team with DHMTs (Medical Technicians) and are equipped with everything needed to treat common to complex...
-
Advanced Practice Provider APP
2 weeks ago
Shrewsbury, United States DispatchHealth Management Full timeJob DescriptionHow You'll Make an Impact: We are hiring Nurse Practitioners and Physician Assistants with acute care experience in ER, Urgent Care, or Internal Medicine to join our growing team serving the Worcester, MA community. Our Advanced Practice Providers team with DHMTs (Medical Technicians) and are equipped with everything needed to treat...
-
Operations Manager
1 month ago
Shrewsbury, United States PDS Health Full timeNow is the time to join Shrewsbury Dentistry. You will have opportunities to learn new skills from our team of experienced professionals. If you're ready to take your career to the next level and gain valuable experience, apply today!The role of the Operations Manager Trainee (OMT) is to gain an understanding of the skills and company knowledge to...
-
Registered Nurse
4 weeks ago
Shrewsbury, United States Veterans Inc. Full timeWith 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...
-
Licensed Practical Nurse-LPN Unit Manager
4 weeks ago
Shrewsbury, United States Complete Care Full timeJob DescriptionOur residents hold a special place as cherished members of our extended family.Choosing a dependable team of caregivers, committed to their promises, is a significant and difficult life decision for any family. As a collective, we take pride in being a sanctuary where individuals in our community can discover compassionate support along their...
-
Licensed Practical Nurse-LPN Unit Manager
2 months ago
Shrewsbury, United States Complete Care Full timeJob DescriptionOur residents hold a special place as cherished members of our extended family.Choosing a dependable team of caregivers, committed to their promises, is a significant and difficult life decision for any family. As a collective, we take pride in being a sanctuary where individuals in our community can discover compassionate support along their...
