RN Nurse Case Manager (Per Diem)

Site: Mass General Brigham Incorporated

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

Per diem shifts will be variable (Day shift Monday through Friday holidays and weekends).

The essential duties of the Insurance Support-Utilization Case Manager are to act as the department coordinator for all insurance workflows that case managers are responsible for; be the department point person for managing and preventing denials and the department expert for understanding payer rules and regulations. The Insurance support- Utilization Case Manager works closely with care coordination medical and surgical physicians nursing staff and other PHS departments that are responsible for billing compliance and finance and revenue integrity.

Key areas of responsibilities include managing day to day payer communication as it relates to supporting hospital admissions; providing UR to payers as needed; managing complex billing decisions; identifying payer trends; responding to payer denials; interfacing with other departments that impact billing and denials; educating care coordination staff about utilization management issues government regulations and other things that impact revenue integrity; and providing reports related to UM as needed.

Qualifications:

• Associates Degree Nursing required or Bachelors Degree Nursing preferred.

• Registered Nurse (RN) License for the State of Massachustetts required.

• 3 years of Medical Surgical experience required.

• Utilization Review (UR) experience strongly preferred.

Additional Skills for Success:

• Giving full attention to what other people are saying taking time to understand the points being made asking questions as appropriate and not interrupting at inappropriate times.

• Using logic and reasoning to identify the strengths and weaknesses of alternative solutions conclusions or approaches to problems.

• Ability to establish strong rapport and relationships with patients and staff.

• Proficient in Microsoft Office and industry related software programs.

• Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.

• Ability to maintain client and staff confidentiality.

• Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care.

• Knowledge of Healthcare and Managed Care preferred.

Working Model and Schedule:

• Fully remote

• Per Diem shifts will be variable (Days Monday through Friday holidays and weekends). Must be available to work at least 8 hours per week and will not work more than 24 hours per week.

• A quiet secure compliant work station is required for remote employees using MGB Issues equipment.

• This role requires employee to reside in New England states (CT MA ME NH RI VT) to be eligible for employment at Newton Wellesley Hospital and for this Union position.

Remote

2014 Washington Street

0

Per Diem

Day (United States of America)

Pay Range

- /Hourly

Grade

RN2600

At Mass General Brigham we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive and any offer extended will take into account your skills relevant experience if applicable education certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however it does not encompass all elements contributing to your total compensation addition to competitive base pay we offer comprehensive benefits career advancement opportunities differentials premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .