Medq Solutions

RN Case Manager.

08-11-2023 Pittsfield,Massachusetts

Job Description :

Urgent need for a RN Case Manager for one of our client which is a Hospital

Pay rate: $65/hr

Job Description:

Use clinical tools, data and other information to complete assessments of patient needs
Create individualized and comprehensive case management and treatment plans
Determine insurance eligibility for various treatments and treatment programs
Clearly explain the reason for prescribed treatments and treatment plans to patients
Educate patients on benefits, services and other resources, including payment options

SUBMISSION REQUIREMENTS

3+ years clinical experience in acute care in areas such as internal medicine, surgery, orthopedics, mother/child, cardiology, and oncology.
3+ years clinical experience in Rehab Setting, Home Health and Long-Term Care would be considered.
Ability to perform a comprehensive admission and discharge risk assessment related to quality, financial, payer benefit allowances and limitations, risk management and patient satisfaction.
Knowledge of regulatory and accreditation organizations such as Joint Commission, DPH and HealthGrades preferred
CASEMGMT - CCM (Certified Case Manager), or ACM (Accredited Case Manager) or RN-BC (Registered Nurse, Board Certification in Case Management)
Experience specializing in utilization management (levels of care knowledge and demonstrable competence with evidence-based criteria tools), discharge planning to entities throughout a continuum of care, previous care management or third-party insurance review required
Current knowledge of CMS (levels of care determinations), appeal rights & DPH regulations required
Current knowledge of Ma Pro QIO (appeals) required
BLS Required
Covid Vaccination required

For more details please contact 425-250-9798

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