School Nurse Jobs

About The Position

Requirements

• Registered Nurse (RN) licensed to practice in Massachusetts.
• 5–7 years of work experience, including at least 3 recent years providing direct service or case management to pediatric, young adult, or adult medically complex populations.
• Ability to travel statewide to Member homes and service providers’ places of business.
• Experience with Office applications and databases.
• Valid driver’s license.

Nice To Haves

• Experience with home care.
• Knowledge of applicable state regulations.
• Experience with prior authorization and/or eligibility determinations.
• Experience caring for medically complex individuals.

Responsibilities

• Serve as the clinical manager for an assigned caseload of Members.
• Contribute to a multidisciplinary team to assess, plan, organize, review, and evaluate Members’ care needs, including 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 in accordance with program guidelines and regulations, meeting established deadlines.
• Prepare and implement Member service records.
• Coordinate, facilitate, and monitor delivery of services to Members.
• Review and document relevant information in data system applications according to 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 for comprehensive clinical reviews and final determinations.
• Evaluate and document the appropriateness of Members’ services and make modifications as required.
• Maintain individual records of Member encounters and contacts, and write clinical summaries.
• Promote continuity of care and partnerships by liaising with health care providers, acute care hospitals, and other programs and organizations involved in service provision.
• Prepare and respond to inquiries related to appeals on clinical determinations.
• Maintain positive working relationships with peers, leadership, Members, informal supports, provider organizations, and state agencies.
• Maintain confidentiality of business documents and correspondence in accordance with UMass Chan Medical School/ForHealth Consulting procedures and HIPAA regulations.
• Participate in performance improvement initiatives and use quality improvement in daily operations.
• Participate in training and onboarding new clinical staff.
• Comply with departmental policies, procedures, and objectives.
• Perform other duties as required.