Nurse Rev II-Case Management
2 weeks ago
OverviewPOSITION SUMMARY: 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. ResponsibilitiesESSENTIAL 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 Member’s 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. QualificationsREQUIRED QUALIFICATIONS: 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 PREFERRED QUALIFICATIONS: Experience with home care Knowledge of applicable state regulations Additional InformationSeeking candidates with experience caring for the medically complex young adult population. Work from home based with visits to client homes/sites. Statewide travel for visits approximately 1-2 times per week.
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Nurse Rev II-Eligibility
3 months ago
Shrewsbury, United States InsideHigherEd Full timeOverviewPOSITION 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 client’s needs, and providing resource support for program...
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Fraud Investigator II
2 months ago
Shrewsbury, United States InsideHigherEd Full timeOverviewGENERAL SUMMARY OF POSITION: Under the general direction of the Associate Director, or designee, the Fraud Investigator II serves a crucial role in combating fraud, waste and abuse (“FWA”) within the Medicaid program. Investigations involve extensive research to identify industry trends and patterns which target aberrant billing practices....
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Disability Reviewer II
1 week ago
Shrewsbury, United States InsideHigherEd Full timeOverviewGENERAL SUMMARY OF POSITION: Under the general direction of the Program Manager or designee, the Disability Reviewer II leads and performs diverse work for multiple State disability determination agencies, Public Retirement Systems and assessments / reviews for the Office of Clinical Affairs and other UMass Chan Medical School (UMass Chan) entities...
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FES Case Manager
3 months ago
Shrewsbury, United States South Middlesex Opportu Full timeJob DescriptionJob DescriptionSUMMARYThe Family Emergency Services (FES) Case Manager provides services to families placed in Emergency Assistance (EA) shelter, referred through the Department of Housing and Community Development (DHCD). Case management will include assessment, service plan development, referrals to community-based resources, advocacy and...
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FES Case Manager
3 months ago
Shrewsbury, United States South Middlesex Opportu Full timeJob DescriptionJob DescriptionSUMMARYThe Family Emergency Services (FES) Case Manager provides services to families placed in Emergency Assistance (EA) shelter, referred through the Department of Housing and Community Development (DHCD). Case management will include assessment, service plan development, referrals to community-based resources, advocacy and...
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Consultant Pharmacist II
3 months ago
Shrewsbury, United States InsideHigherEd Full timeOverviewPOSITION 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 regards to...
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Nurse Reviewer II-Eligibility
1 week ago
Shrewsbury, United States InsideHigherEd Full timeOverviewPOSITION 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 client’s needs, and providing resource support for program...
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Case Manager
1 month ago
Shrewsbury, United States Veterans Inc. Full timeJob DescriptionJob DescriptionAre you motivated by knowing you've made a difference in someone's life and in our community? Do you have a passion for helping those in substance abuse recovery? If you answered yes, then you may have what it takes to be part of the Veterans Inc. team at Independence Hall!At Independence Hall, we provide client-centered...
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Consultant Pharmacist II
3 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...
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Nurse Reviewer II
2 months ago
Shrewsbury, United States InsideHigherEd Full timeOverviewPOSITION 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 client’s needs, and providing resource support for program...
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Disability Reviewer II
3 days ago
Shrewsbury, Massachusetts, United States University of Massachusetts Medical School Full timeJob Summary:The University of Massachusetts Medical School seeks a skilled Disability Reviewer II to join our team. As a Disability Reviewer II, you will play a critical role in leading and performing diverse work for multiple State disability determination agencies, Public Retirement Systems, and assessments/reviews for the Office of Clinical Affairs and...
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Clinical Therapist II
2 months ago
Shrewsbury, United States Hackensack Meridian Health Full timeOverview Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives - and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It's also about how we support one...
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Clinical Therapist II
3 months ago
Shrewsbury, United States Hackensack Meridian Health Full timeOverview Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one...
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Product Engineer II- Electrical
3 months ago
Shrewsbury, United States Danaher Corporation Full timeBe part of something altogether life-changing! Working at Cytiva means being at the forefront of providing new solutions to transform human health. Our incredible customers undertake life-saving activities ranging from fundamental biological research to developing innovative vaccines, new medicines, and cell and gene therapies. At Cytiva you will be able to...
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Electrical Product Engineer II
2 weeks ago
Shrewsbury, Massachusetts, United States Danaher Corporation Full timeBe part of a transformative journeyAt Cytiva, we are at the forefront of delivering innovative solutions that enhance human health. Our esteemed clients engage in life-saving endeavors, from essential biological research to the creation of groundbreaking vaccines, novel medicines, and advanced cell and gene therapies.Joining Cytiva means embracing a culture...
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Client Care Manager
2 days ago
Shrewsbury, New Jersey, United States Homewatch CareGivers of Eatontown Full timeJob DescriptionWe are seeking a highly skilled and compassionate Client Care Manager to join our team at Homewatch CareGivers of Eatontown. As a key member of our staff, you will be responsible for providing exceptional care and support to our clients and their families.Key Responsibilities:Client Service-Case Management:Handle and validate initial leads...
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QC/QA Incoming Inspector II
2 weeks ago
Shrewsbury, United States Repligen Full timeOverview Working at Repligen means being part of a team that is excited to find new and creative ways to overcome challenges in bioprocessing - and to help our customers make a difference in the world. The QC/QA Inspector II will report directly to the Quality Lead, Quality Manager or Director. This position is responsible to actively participate in the...
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QC/QA Incoming Inspector II
4 weeks ago
Shrewsbury, United States Repligen Corporation Full timeWorking at Repligen means being part of a team that is excited to find new and creative ways to overcome challenges in bioprocessing — and to help our customers make a difference in the world. The QC/QA Inspector II will report directly to the Quality Lead, Quality Manager or Director. This position is responsible to actively participate in the Repligen...
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QC/QA Incoming Inspector II
4 weeks ago
Shrewsbury, United States Repligen Corporation Full timeWorking at Repligen means being part of a team that is excited to find new and creative ways to overcome challenges in bioprocessing — and to help our customers make a difference in the world. The QC/QA Inspector II will report directly to the Quality Lead, Quality Manager or Director. This position is responsible to actively participate in the Repligen...
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Survey Data Analyst
2 months ago
Shrewsbury, United States InsideHigherEd Full timeOverviewGENERAL SUMMARY OF POSITION:Under the general direction of the department head or designee, the Biostatistician II will assist in the planning, design, review, programming and implementation of special information systems activities. Responsibilities ESSENTIAL...
