RN Case Review Coordinator - Per Diem - Faulkner
About The Position
Site: Brigham and Women's Faulkner Hospital, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Schedule: Per Diem Job Summary Performs the six essential activities of Case Management: Assessment, Planning, Implementation, Coordinate, Monitor and Reassess through the continuum of care to facilitate a safe cost-effective transition post discharge. Performs all aspects of audits and appeals including the peer to peer process.
Requirements
- BSN required.
- Current Registration as a Licensed Nurse in the State of Massachusetts.
- 3 year of Utilization Review and Case Management experience required, 4 or more years preferred
- 5 years of Acute Care Nursing Required 6 or more preferred
Nice To Haves
- CCM preferred.
Responsibilities
- Perform utilization review to evaluate for appropriate level of care and faxes all insurance reviews timely to prevent denials.
- Collaborate with patient/family and interdisciplinary team to assess for appropriate discharge needs.
- Place and implement all aspects of referrals to all levels of post acute care in 4 Next.
- Online documentation of interaction with patient, family and interdisciplinary team.
- Interact with various third party payers on a daily basis. Fax clinical in payor communication to the right insurer with the right fax number in the right time frame.
- Refer cases not meeting appropriate level of care to the Physician Advisor or EHR.
- Review for Observation status and make changes as needed. Accurately facilitate all documentation needed for Medicare status change inpatient to observation (code 44).
- Perform and monitor for quality issues and document in R.L. solutions.
- Provide to the patient or family member a copy of the Important Message
- Provide to the patient or representative the Observation Notification letter
- Provide to the patient representative the Acknowledgement of disclosure ,obtain choices of post acute facilities or service and signature
- Must be able to function independently in busy environment.
- Coordinate, complete and track all clinical denials and appeals.
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What This Job Offers
Job Type
Part-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees
