Clinical Case Reviewer - RN Needed

Clinical Case Reviewer - RN Needed
in Watertown, Massachusetts 02109 - US

Job Description

Clinical Case Reviewer - RN Needed

We are one of the largest healthcare providers nationwide looking to add staff immediately in our office located in Watertown. This Clinical Case Manager position is full time and provides excellent benefits. The ideal candidate should have previous case management experience or clinical RN experience. You'll be joining our team of 8 working in a busy health care services office. This position requires candidates that have the ability to comminute with families, patients, and the medical staff on a professional level.

• 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.

• 1-3 years of clinical or case management experience in medical/surgical care settings.
• RN license or a Bachelor's Degree in Nursing
• Excellent communication skills. Able to discuss sensitive/ confidential information in a professional, unbiased manner.
• Proven customer service skills working with providers and members to ensure satisfaction of interaction

If you're interested in joining our team, please submit a 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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