Nurse Rev II-Eligibility
1 month ago
POSITION 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 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.
ResponsibilitiesESSENTIAL 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:
- Bachelor’s 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.
- Targeted geograhic area- Southeastern MA & Cape Cod
-
Nurse Rev II-Eligibility
6 days ago
Shrewsbury, United States University of Massachusetts Medical School Full timeOverview POSITION 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...
-
Nurse Rev II-Eligibility
4 weeks 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...
-
Nurse Rev II-Eligibility
6 days 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...
-
Nurse Practitioner, Internal Medicine
2 weeks ago
Shrewsbury, United States UMass Memorial Health Care Full timeEveryone Is a Caregiver At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 16,000...
-
Licensed Practical Nurse
2 weeks ago
Shrewsbury, United States Brandywine Senior Living Full timeLicensed Practical Nurse (LPN) Do you want to be part of a TEAM that changes lives? "When I came to Brandywine I noticed how different it was to other facilities, particularly skilled nursing. Here you could spend more time with the residents. I fell in love with the feel of the building and the residents. It felt more personal. "- Brandywine Living Nurse ...
-
Licensed Practical Nurse
6 days ago
Shrewsbury, United States Brandywine Senior Living Full timeLicensed Practical Nurse (LPN) Do you want to be part of a TEAM that changes lives? "When I came to Brandywine I noticed how different it was to other facilities, particularly skilled nursing. Here you could spend more time with the residents. I fell in love with the feel of the building and the residents. It felt more personal. "- Brandywine Living Nurse ...
-
Clinical Reviewer DMH PASRR
3 weeks ago
Shrewsbury, United States University of Massachusetts Medical School Full timeOverview GENERAL SUMMARY OF POSITION: Under the general supervision of the Associate Director, or designee, the Clinical Reviewer II is responsible for completing Pre-Admission Screening Resident Reviews (PASSR) Level II Evaluations by conducting face to face evaluations and reviewing medical records, in accordance with relevant guidelines and regulations....
-
Clinical Reviewer DMH PASRR
1 week ago
Shrewsbury, United States University of Massachusetts Medical School Full timeOverview GENERAL SUMMARY OF POSITION: Under the general supervision of the Associate Director, or designee, the Clinical Reviewer II is responsible for completing Pre-Admission Screening Resident Reviews (PASSR) Level II Evaluations by conducting face to face evaluations and reviewing medical records, in accordance with relevant guidelines and regulations....
-
Clinical Reviewer DMH PASRR
3 weeks ago
Shrewsbury, United States InsideHigherEd Full timeOverviewGENERAL SUMMARY OF POSITION: Under the general supervision of the Associate Director, or designee, the Clinical Reviewer II is responsible for completing Pre-Admission Screening Resident Reviews (PASSR) Level II Evaluations by conducting face to face evaluations and reviewing medical records, in accordance with relevant guidelines and regulations....
-
Certified Nursing Assistant
2 weeks ago
Shrewsbury, Massachusetts, United States IntelyCare Full timeMake up to $33 an hour as a Certified Nursing Assistant (CNA) 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...
-
Certified Nursing Assistant
1 week ago
Shrewsbury, Massachusetts, United States IntelyCare Full timeMake up to $33 an hour as a Certified Nursing Assistant (CNA) 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...
-
Clinical Reviewer DMH PASRR
2 weeks ago
Shrewsbury, United States University of Massachusetts Medical School Full timeGENERAL SUMMARY OF POSITION: Under the general supervision of the Associate Director, or designee, the Clinical Reviewer II is responsible for completing Pre-Admission Screening Resident Reviews (PASSR) Level II Evaluations by conducting face to face evaluations and reviewing medical records, in accordance with relevant guidelines and regulations. This...
-
Clinical Reviewer DMH PASRR
9 hours ago
Shrewsbury, United States University of Massachusetts Medical School Full timeGENERAL SUMMARY OF POSITION: Under the general supervision of the Associate Director, or designee, the Clinical Reviewer II is responsible for completing Pre-Admission Screening Resident Reviews (PASSR) Level II Evaluations by conducting face to face evaluations and reviewing medical records, in accordance with relevant guidelines and regulations. This...
-
Certified Nursing Assistant
2 weeks ago
Shrewsbury, United States IntelyCare Full timeMake up to $33 an hour as a Certified Nursing Assistant (CNA) 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...
-
Certified Nursing Assistant
1 week ago
Shrewsbury, United States IntelyCare Full timeMake up to $33 an hour as a Certified Nursing Assistant (CNA) 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...
-
Registered Nurse
1 week ago
Shrewsbury, United States Encompass Health Full timeLocated in Worcester Hiring for all positions full-time and part-time days and nights available. Hourly rate range $41. 00 - $54.50 / hour Excellent PRN rates as well Compensation will be determined based on years of experience and applicable certifications. This position also includes generous shift differentials Registered Nurse Career Opportunity...
-
Psychiatric Mental Health Nurse Practitioner
5 days ago
Shrewsbury, United States University of Massachusetts Full timeOverview GENERAL SUMMARY OF POSITION: Reporting to the Facility Medical Director, the psychiatric-mental health nurse practitioner (PMHNP) provides comprehensive behavioral health care to adult patients in either an inpatient or outpatient setting. The patient population served consists of adults with chronic and persistent mental health...
-
Travel Registered Nurse
2 weeks ago
Shrewsbury, United States TravelNurseSource Full timeTravelNurseSource is working with Core Medical Group to find a qualified Home Health RN in Shrewsbury, Massachusetts, 01545!Pay Information$2,820 per weekAbout The Position CoreMedical Group has hundreds of exciting and rewarding travel assignments throughout the country for Travel Allied Professionals and Travel Nurses. Plus, we're the only healthcare...
-
Travel Nurse RN
5 days ago
Shrewsbury, United States CoreMedical Group Full timeCore Medical Group is seeking a travel nurse RN Home Health for a travel nursing job in Shrewsbury, Massachusetts. Job Description & Requirements Specialty: Home Health Discipline: RN Start Date: 06/03/2024 Duration: 13 weeks 40 hours per week Shift: 8 hours Employment Type: Travel CoreMedical Group has hundreds of exciting and rewarding travel...
-
Travel Nurse RN
2 weeks ago
Shrewsbury, United States Core Medical Group Full timeJob DescriptionCore Medical Group is seeking a travel nurse RN Home Health for a travel nursing job in Shrewsbury, Massachusetts.Job Description & RequirementsSpecialty: Home HealthDiscipline: RNStart Date: 06/03/2024Duration: 13 weeks40 hours per weekShift: 8 hoursEmployment Type: Travel CoreMedical Group has hundreds of exciting and rewarding travel...