RN Case Review Coordinator - Per Diem - Faulkner

Site: Brigham and Women's Faulkner Hospital, Inc. 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. About Brigham and Women's Faulkner Hospital Brigham and Women's 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 Women's Faulkner Hospital offers comprehensive care in a wide variety of specialties. Brigham and Women’s 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 Women’s 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 you’re looking for more than a career, join Brigham and Women’s Faulkner Hospital. Our patients call it better care. Our employees call it home. Additional Job Details (if applicable) Schedule: Per Diem Remote Type Hybrid Work Location 1133 Centre Street Scheduled Weekly Hours 0 Employee Type Per Diem Work Shift 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. EEO Statement: 2810 Brigham and Women's Faulkner Hospital, Inc. 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 Veteran’s 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 View phone number on click.appcast.io. 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. Combat disease. Hold a hand. Help people. Impact the world. Mass General Brigham is a passionate, welcoming community where minds meet caring hearts. Come be a part of the world’s most powerful force in medicine, where every role is important in changing lives. Are you ready? Our history includes New England hospitals founded over 200 years ago, some of the first and most prestigious hospitals in the world. Built on the legacy of two leading academic medical centers, we’re more than a system—we’re leaders in the practice of medicine. Mass General Brigham is committed to serving the community. We are dedicated to enhancing patient care, teaching and research, and taking a leadership role as an integrated health care system. We recognize that increasing value and continuously improving quality are essential to maintaining excellence.