Nursing Jobs in Sudbury, 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. 
$90,000 - $125,000 / year
If you're ready to leave a hectic hospital environment and are passionate about working with adolescents, this may be the role for you! Who We Are Looking For: Are you the Director of Nursing we have been looking for? In this position, you will be able to convey your passion for helping others while leading a dynamic team of nurses by bringing an energetic and positive approach while working with our students! Walden Street School is a residential treatment setting for adolescents that specializes in trauma informed care. Walden provides 24-hour comprehensive care including a school on site, a full clinical staff, nursing staff, and direct care staff. Compensation The pay range for this position is $90,000 to $125,000 per year. The listed range reflects what we reasonably and in good faith expect to pay for this role at the time of posting the position. The actual compensation an employee is offered may vary based on several factors such as experience, education, licensure, certifications and qualifications. This range may be modified in the future. JRI Provides The Training So That: YOU will be able to develop your skills in providing oversight and development of systems and functioning of the nursing department. YOU will be able to lead a team to provide all administrative functions in the nursing department, including supervision of staff, audits, appointments, paperwork, and communication with guardians and outpatient healthcare providers YOU will be able to help students and families navigate their medical needs and help provide valuable skills to ensure the students are successful in their next steps. Why JRI? Be who you are! JRI is committed to creating a workplace built on respect, collaboration, and opportunity, where every employee is valued and supported in making a meaningful impact. We offer a $2,000 bilingual bonus to new hires who speak a second language other than English! Reimbursement is available for employees to cover the registration costs and annual fees for any professional license required for work such as LMHC, LCSW, LICSW, RN and more! Access to our excellent Blue Cross medical and Delta Dental benefits. Retirement benefits including 401K matched up to $800 a year and pension after 5 years of employment. Professional development opportunities such as tuition reimbursement up to almost $4000 per year and discounted tuition rates to select partnership colleges and universities! Wellness benefits including access to employee engagement groups, self-care resources, and an Employee Assistance Program. Generous paid time off up to 19 days for full time employees in your first year and much more! Requirements: Massachusetts RN license Nursing management experience preferred Residential program or mental health program experience preferred; experience working with specialized adolescent populations preferred. Meet programs background and driving record check requirements Maintains valid driver’s license. Available to work evenings, holidays, weekend shifts as necessary. Background and driving record checks will be performed. At JRI, we are committed to fostering a workplace where every team member feels valued and respected. We believe that a culture built on mutual respect, collaboration, and opportunity allows our staff to thrive and do their best work. By supporting one another and recognizing each person's contributions, we create an environment where people can grow, develop their skills, and make a meaningful impact in the communities we serve. JRI is an equal opportunity employer. #INDDIR 
