RN Case Review Coordinator Per Diem Faulkner
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Job Location:
Jamaica Plain, MA - USA
Hourly Salary:
$ 41 - 100
Posted on:
2 hours ago
Vacancies:
1 Vacancy
Job Summary
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.
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.- 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.
Qualifications
- 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
- CCM preferred.
Additional Job Details (if applicable)
About Brigham and Womens Faulkner Hospital
Brigham and Womens Faulkner Hospital is a 171- bed non-profit community teaching hospital located in Jamaica Plain directly across the street from the Arnold Arboretum. Founded in 1900 Brigham and Womens Faulkner Hospital offers comprehensive care in a wide variety of specialties. Brigham and Womens Faulkner Hospital is a designated Magnet hospital by the American Nurses Credentialing Center a recognition that fewer than nine percent of all US hospitals receive.
At Brigham and Womens Faulkner Hospital we believe that everyone should have the chance to live a healthy life. From creating breakthroughs that have paved the way for treatments around the globe to training the next generation of providers our patients and those we may never meet are at the center of everything we do. If youre looking for more than a career join Brigham and Womens Faulkner Hospital. Our patients call it better care. Our employees call it home.
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$41.36 - $100.00/HourlyGrade
RN3500EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Required Experience:
IC
Key Skills
- Project Portfolio Management
- Motivational Interviewing
- HIPAA
- Computer Skills
- Intake Experience
- Lean Six Sigma
- Conflict Management
- Case Management
- Team Management
- Program Development
- Social Work
- Addiction Counseling
About Company
Patients at Mass General have access to a vast network of physicians, nearly all of whom are Harvard Medical School faculty and many of whom are leaders within their fields.
