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- Tasks: Manage a caseload, assess care needs, and coordinate services for community members.
- Company: Join ForHealth Consulting at UMass Chan Medical School, a leader in healthcare innovation.
- Benefits: Enjoy flexible home-based work with opportunities for client visits and professional growth.
- Why this job: Make a real impact in people's lives while working in a supportive, collaborative environment.
- Qualifications: Must be an RN in Massachusetts with 5-7 years of relevant experience.
- Other info: Ideal for those passionate about community health and improving patient care.
The predicted salary is between 36000 - 60000 £ per year.
Nurse Reviewer II-Case Mgt (Home Based with Client Visits)
Join to apply for the Nurse Reviewer II-Case Mgt (Home Based with Client Visits) role at ForHealth Consulting at UMass Chan Medical School
Nurse Reviewer II-Case Mgt (Home Based with Client Visits)
3 weeks ago Be among the first 25 applicants
Join to apply for the Nurse Reviewer II-Case Mgt (Home Based with Client Visits) role at ForHealth Consulting at UMass Chan Medical School
Position Summary
Under the general supervision of the Associate Director, Clinical Coordinator, 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 long term services and supports (LTSS) 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.
Position Summary
Under the general supervision of the Associate Director, Clinical Coordinator, 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 long term services and supports (LTSS) 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, meeting all established deadlines.
- 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.
- Prepare and respond to inquiries related to appeals on clinical determinations.
- Maintain positive working relationships with peers, leadership, 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.
- Participates in training and onboarding of new clinical staff
- Comply with established departmental policies, procedures and objectives.
- Perform other duties as required.
Required 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 the pediatric, young adult, or adult medically complex population
- Ability to travel statewide to Member homes and service providers places of business
- Experience with Office Application and database
- Valid Drivers license required
Preferred Qualifications
- Experience with home care
- Knowledge of applicable state regulations
- Experience with prior authorization and/or eligibility determinations
- Experience with the care of medically complex individuals
The University of Massachusetts Chan Medical School welcomes all qualified applicants and complies with all state and federal anti-discrimination laws.
Seniority level
-
Seniority level
Not Applicable
Employment type
-
Employment type
Full-time
Job function
-
Job function
Health Care Provider
-
Industries
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Nurse Reviewer II-Case Mgt (Home Based with Client Visits) employer: ForHealth Consulting at UMass Chan Medical School
Contact Detail:
ForHealth Consulting at UMass Chan Medical School Recruiting Team
StudySmarter Expert Advice 🤫
We think this is how you could land Nurse Reviewer II-Case Mgt (Home Based with Client Visits)
✨Tip Number 1
Network with professionals in the healthcare field, especially those who work in case management or have experience with long-term services and supports. Attend local healthcare events or join online forums to connect with others who can provide insights or even referrals for the Nurse Reviewer II position.
✨Tip Number 2
Familiarise yourself with the specific regulations and guidelines related to community case management in Massachusetts. Understanding these will not only help you in interviews but also demonstrate your commitment to the role and the organisation's mission.
✨Tip Number 3
Prepare to discuss your experience with multidisciplinary teams during interviews. Highlight specific examples where you successfully collaborated with various healthcare providers to improve patient outcomes, as this is a key aspect of the Nurse Reviewer II role.
✨Tip Number 4
Showcase your knowledge of home care practices and your ability to conduct on-site assessments. Be ready to explain how you would approach evaluating a member's needs in their home environment, as this is crucial for the position.
We think you need these skills to ace Nurse Reviewer II-Case Mgt (Home Based with Client Visits)
Some tips for your application 🫡
Tailor Your CV: Make sure your CV highlights relevant experience in case management and working with medically complex populations. Emphasise your nursing qualifications and any specific skills that align with the job description.
Craft a Compelling Cover Letter: Write a cover letter that showcases your passion for community-based services and your understanding of the role. Mention specific experiences that demonstrate your ability to assess and coordinate care effectively.
Highlight Relevant Qualifications: Clearly state your RN licence and any additional certifications or training that are pertinent to the position. If you have experience with home care or prior authorisation processes, make sure to include that.
Showcase Team Collaboration Skills: Since this role involves working within a multidisciplinary team, provide examples of how you've successfully collaborated with other healthcare professionals in the past. This will demonstrate your ability to foster continuity of care.
How to prepare for a job interview at ForHealth Consulting at UMass Chan Medical School
✨Showcase Your Clinical Experience
Make sure to highlight your relevant clinical experience, especially in case management and working with medically complex populations. Be prepared to discuss specific cases where you successfully coordinated care or made a significant impact on a patient's journey.
✨Demonstrate Team Collaboration Skills
As the role involves working within a multidisciplinary team, share examples of how you've effectively collaborated with other healthcare professionals. Discuss any challenges you faced and how you overcame them to ensure continuity of care for your patients.
✨Familiarise Yourself with Regulations
Brush up on applicable state regulations and guidelines related to long-term services and supports (LTSS). Being knowledgeable about these can help you answer questions confidently and demonstrate your commitment to compliance and quality care.
✨Prepare for Scenario-Based Questions
Expect scenario-based questions that assess your problem-solving skills and decision-making abilities. Think of situations where you had to evaluate care needs or make service modifications, and be ready to explain your thought process and outcomes.
