Clinical Case Review - RN experience needed

Clinical Case Review - RN experience needed
in Boston, Massachusetts 02109 - US

Job Description

Clinical Case Review - RN experience needed

There is an immediate need in our office to hire a Clinical Case Reviewer to join our team of case managers here on the south shore in Quincy. Our department is fast paced and growing at such a rate that we're looking to add staff right away. The Clinical Case Reviewer will be responsible for handling cases for patients and families. Polished customer service skills are a must in this full-time position acting as a liaison between members and our medical staff.

Other responsibilities include:
- Focuses on efficient utilization management with emphasis on discharge planning. Case management components may be required.
- Understands and appropriately manages member's benefits to maximize health care quality.
- Collaborates with physician reviewers, case managers, project leaders and associates to optimize member care
- Facilitates review process by communication with members, families, providers, and medical staff for information relating to benefits
- Collaborates with members, families, providers, medical staff and the treatment team in order to develop, implement, authorize, and document treatment plans that include treatment goals, interventions, and expected clinical outcomes.
- Educates and support members and families regarding benefits, eligibility, policies and processes with the goal to empower self-advocacy.
- Efficiently enter case information, check benefits and eligibility look up policy and procedures, validate provider contractual status and other functions relating to the execution of key responsibilities.
- Exhibits customer satisfaction orientation in every aspect of carrying out responsibilities.
- Completes cost avoidance and other reports and tracking tools to capture impact and/or scope of medical management

- Registered Nurse with an active professional Massachusetts license.
- 1-3 years of Case Management experience preferred.
- Ability to discuss sensitive and confidential information in a polished and unbiased manner.
- Excellent organizational skills, ability to manage multiple ongoing tasks.
- A working understanding of Microsoft Word, Excel and Outlook.

If you're interested in applying for this role or learning more about our organization, please submit your resume
For questions, please call 617-250-1000. There are no costs for candidates utilizing our services as our clients pay for all related hiring fees. All PSG job postings are either actual positions we had available at the time of posting and/or are representative of positions we typically fill or expect to fill. If you see a job that interests you, respond to the ad or give us a call so that we can help you find a job you'll love. As one of the area's largest staffing firms, we help 2,500 people find jobs a year so chances are good that we can help you too.

Professional Staffing Group is an equal opportunity employer and considers qualified applicants for employment regardless of race, gender, gender identity, gender expression, age, color, religion, disability, veteran's status, sexual orientation, or any other protected factor.



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