Nursing Jobs in Hamilton, MA
$62,700 - $100,400 / YEAR
Job Summary: Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services, assisting with discharge planning activities (i.e. DME, home health services) and care coordination for members, as well as monitoring the delivery of healthcare services. Essential Functions: Complete prospective, concurrent and retrospective review such as acute inpatient admissions, post-acute admissions, elective inpatient admissions, outpatient procedures, homecare services and durable medical equipment Identify, document, communicate, and coordinate care, engaging collaborative care partners to facilitate transitions to an appropriate level of care Engage with medical director when additional clinical expertise if needed Maintain knowledge of state and federal regulations governing CareSource, State Contracts and Provider Agreements, benefits, and accreditation standards Identify and refer quality issues to Quality Improvement Identify and refer appropriate members for Care Management Provide guidance to non-clinical staff Provide guidance and support to LPN clinical staff as appropriate Attend medical advisement and State Hearing meetings, as requested Assist Team Leader with special projects or research, as requested Perform any other job related duties as requested. Education and Experience: Associates of Science (A.S) Completion of an accredited registered nursing (RN) degree program required Three (3) years clinical experience required Med/surgical, emergency acute clinical care or home health experience preferred Utilization Management/Utilization Review experience preferred Medicaid/Medicare/Commercial experience preferred Competencies, Knowledge and Skills: Proficient data entry skills and ability to navigate clinical platforms successfully Working knowledge of Microsoft Outlook, Word, and Excel Effective oral and written communication skills Ability to work independently and within a team environment Attention to detail Proper grammar usage and phone etiquette Time management and prioritization skills Customer service oriented Decision making/problem solving skills Strong organizational skills Change resiliency Licensure and Certification: Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice required MCG Certification or must be obtained within six (6) months of hire required Working Conditions: General office environment; may be required to sit or stand for extended periods of time Travel is not typically required Compensation Range: $62,700.00 - $100,400.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Hourly Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. $70,345.60 - $136,333.60 / YEAR
Site: Mass General Brigham Incorporated 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 The Access RN will lead critical system-wide coordination efforts by adopting a system mindset and leveraging their clinical expertise, situational awareness, and knowledge of MGB hospital capabilities to match patients with the right site of care efficiently and effectively. This centralized role aims to ensure timely access to care, reduce transfer delays, balance patient flow, activate standardized transfer pathways, and foster close collaboration with the multidisciplinary MGB PTAC team and site-based clinical and operational leaders. Does this position require Patient Care? Yes Essential Functions -Facilitates and coordinates closely with hospital bed management teams in the MGB Capacity Center to facilitate patient movement and placement across the system. -Elicits patient information from the referring MD and the outside facility nurse to allow appropriate patient triage and placement. Follows admission using the Transfer matrix and alternative pathways based on bed availability in collaboration with patient access services to appropriate beds based on bed availability and triage information. Collaborates with off-shift nurse administrators regarding ED, procedures, and inpatient arrivals. -Monitors the notification process for inpatient responding clinicians, appropriate documents including data collection, IPASS expect notes, transfer modules, emails, code activations, and reporting to senior leadership. Access nurses notify the team and inpatient service of admission via email to attending physicians; expect a note to be placed for house staff, and collaboration with the referring physician callback for specific information. -Serves as a department representative and consults with appropriate administrators, patient care unit leadership, procedural unit leadership, and access services during the extreme census—updates physicians and transferring facilities on bed availability. Attend daily huddles and represent the PTAC. -Responsible for making critical decisions on directing patients to the appropriate care pathway across various diagnoses, clinical scenarios, and operationally challenging situations. -Identifies patients who are safe and appropriate for standardized transfer pathways that avoid the ED and/or reduce the load on inpatient bed capacity at MGB hospitals. Coordinate these transfers with hospital-based and other MGB asset-based physicians, nurses, and capacity leaders. Qualifications Education Bachelor's Degree in Nursing required Licenses and Credentials: Registered Nurse [RN - State License] required Experience 3+ years of adult critical care and/or emergency department experience required Knowledge, Skills and Abilities Must work well independently, have sound decision-making skills, and have flexibility to assist in times of emergency or increased need. Responsible for contributing to a calm, organized, appreciative, learning-oriented atmosphere. Proactively seeks out feedback and communicates development goals. Additional Job Details (if applicable) Remote Type Onsite Work Location 399 Revolution Drive Scheduled Weekly Hours 32 Employee Type Regular Work Shift Night (United States of America) Pay Range $70,345.60 - $136,333.60/Annual Grade 6NTEMP 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: 0100 Mass General Brigham Incorporated 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 (857)-282-7642. 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. 
