Site: Brigham and Women's Faulkner Hospital, Inc.
Job Summary
Schedule: Full-time; 40 hours
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.
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)
Remote Type
Onsite
1153 Centre Street
40
Regular
Day (United States of America)
Pay Range
$41.36 - $100.00/Hourly
Grade
RN3500
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 package. In 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.
