Nurse Case Consultant

1 week ago


Shrewsbury, Shropshire, United Kingdom University of Massachusetts Medical School Full time

We are seeking an experienced Nurse Case Consultant to join our team at the University of Massachusetts Medical School. As a key member of our review process, you will be responsible for assessing clinical eligibility, prior authorizations, and providing case consultation by reviewing medical records and providing resource support for program participants.

About the Role:
  • You will conduct on-site reviews and reassessments of applicant/participant/informal supports ability to assist with providing care when determining the medical necessity and clinical eligibility for assigned program and health care services.
  • You will review and document all relevant information into data system applications in accordance with program guidelines and regulations.
  • You will conduct routine and ad-hoc evaluations and re-evaluations of applicants/participants services.
  • You will prepare and respond to requests for statistics and resource/service data.
  • You will foster and promote continuity of care and cooperative partnerships by liaising with health care providers, acute care hospitals, long term care facilities and other programs/organizations involved in the provision of services.
  • You will maintain the confidentiality of all business documents and correspondence per UMass Chan Medical School/ForHealth Consulting procedures and HIPAA regulations.
  • You will participate in performance improvement initiatives and demonstrates the use of quality improvement in daily operations.
  • You will comply with established departmental policies, procedures and objectives.
  • You will comply with all health, safety and program regulations and requirements.
What We Offer:
  • A competitive salary range of $80,000 - $110,000 per year.
  • A comprehensive benefits package.
  • Ongoing training and professional development opportunities.

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