RN Case Review Coordinator Faulkner
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Job Location:
Jamaica Plain, MA - USA
Hourly Salary:
$ 41 - 100
Posted on:
30+ days 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
Why YOU should be our newest Case Review Coordinator:Performs the six essential activities of Case Management: Assessment Planning Implementation coordinating monitoring and Reassessing 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 the appropriate level of care and fax all insurance reviews timely to prevent denials.
Collaborate with patient/family and interdisciplinary team to assess for appropriate discharge needs.
Interact with various third-party payers on a daily basis.
Review for Observation status and make changes as needed.
Qualifications
Bachelors Degree Nursing required
3 year of Utilization Review and Case Management experience preferred or 4 or more years of Utilization Review and Case Management experience preferred
5 years of Acute Care Nursing required or 6 or more of Acute Care Nursing preferred
Staff adheres to all I C.A.R.E. Standards.
Demonstrates knowledge skills and abilities to work with various age groups in order to provide a safe discharge plan.
Must be able to provide care for the patient despite psychosocial educational or physical disability.
Basic computer skills experience with Excel and Word and good computation skills.
Ability to interact and communicate within a diverse community.
Competent in Utilization Review appeals the peer-to-peer process and Case Management.
Use critical thinking skills in all interactions and recognize the need to be solution-driven.
Good negotiating skills with insurance companies and third-party payers.
Performs all aspects of discharge planning to the right environment of care timely.
Proficient in the use of ECare.
Who We Are:
Brigham and Womens Faulkner Hospital is an affiliate of Mass General Brigham committed to supporting patient care research teaching and service to the community.
Brigham and Womens Faulkner Hospital is a 171- bed non-profit community teaching hospital located in Jamaica Plain. Founded in 1900 Brigham and Womens Faulkner Hospital offers comprehensive care in a wide variety of specialties. We are a Magnet designated hospital a recognition that fewer than nine percent of all US hospitals 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 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.
Additional Job Details (if applicable)
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.
