Pediatric Nurse Clinical Manager
University of Massachusetts Medical School - Shrewsbury, MA

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The Nurse Reviewer II, under the general supervision of the Associate Director, is responsible for providing administrative case management as part of the Community Case Management Program. This position is responsible for the authorization, coordination and facilitation of home care services for medically complex children and young adult MassHealth members for MassHealth’s Community Long Term Care services.

This position fosters and promotes continuity of care and cooperative partnerships by liaising with nursing providers, state agency staff, acute care hospitals and other programs/organizations involved in the provision of services.

Responsibilities:

MAJOR RESPONSIBILITIES:
  • Serve as the clinical manager for an assigned caseload of CCM member
  • Act as an active member of a multi-disciplinary case management team
  • Conduct on-site intake and reassessments to determine clinical eligibility for the program and long term care services
  • Determine and authorize services for members in accordance with program guidelines and MassHealth regulations
  • Prepare and implement member service plans
  • Conduct routine and ad hoc reviews and re-evaluations of member services
  • Coordinate, facilitate and monitor the delivery of services to members
  • Document all member encounters and contacts; writes nursing summaries
  • Evaluate and document the progress of members' services and make modifications, as required
  • Travels statewide to member homes and service providers places of business
  • Review and data enter member information and service authorizations in relevant information system applications in accordance with program guidelines and regulations
  • Request medical records from treating sources in writing, by telephone or by fax
  • Maintain individual records documenting individual specific activities
  • Prepare and respond to requests for case statistics and resource/service data
  • Foster and promote continuity of care and cooperative partnerships by liaising with nursing providers, acute care hospitals and other programs/organizations involved in the provision of services
  • Participate in public relations efforts, attending conferences and meetings as needed
  • Maintain positive working relationships with members, member's informal supports, provider organizations, and state agencies
  • Maintain the confidentiality of all business documents and correspondence
  • Participate in performance improvement initiatives and demonstrates the use of quality improvement in daily operations
  • Attend and participate in meetings, as required
  • Comply with established departmental policies, procedures and objectives
  • Comply with all health and safety regulations and requirements
  • Perform other similar and related duties as required or as directed
Qualifications:

REQUIRED QUALIFICATIONS:
  • RN licensed to practice in Massachusetts
  • Bachelor's Degree in Nursing, or RN plus 5-10 years work experience or equivalent
  • 3-5 years related work experience providing direct service or case management to pediatric patients with special needs
  • Statewide travel required
  • Experience with Word and Excel and other desktop tools
PREFERRED QUALIFICATIONS:
  • Experience with home care preferred
SUPERVISION RECEIVED :

Under the general direction of the Director or designee

SUPERVISION EXERCISED:

None

ENVIRONMENTAL WORKING CONDITIONS:
  • Stressful working environment meeting state agency defined deadlines for the completion of reports, data entry and compliance with contractual requirements.
  • Must be able to carry out the essential functions of this position, with reasonable accommodation if disabled.

University of Massachusetts Medical School - 19 months ago - save job - block
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