Sorry, this job is no longer accepting applications. See below for more jobs that match what you’re looking for!

Case Manager

Expired Job

Cambridge Health Alliance Cambridge , MA 02138

Posted 2 months ago

Under the general supervision of the Director of Care Management, the RN Case Manager provides clinically-based case management to support the delivery of effective and efficient patient care consistent with the Centers for Medicaid and Medicare Conditions of Participation.
The RN Case Manager will collaborate with other members of the health care team to identify appropriate utilization of resources and to ensure reimbursement.
Utilize criteria to confirm medical necessity for admission and continued stay.
With the patient, family and health care team, create a post-acute care plan appropriate to the patient's needs and resources and facilitate this transition in concert with that patient's inpatient and post-acute care teams.
Completes an initial screen of all patients within 24 hours of admission utilizing specific criteria (i.e.- Interqual) to identify needs related to utilization management and post-acute care planning.

Based on input and direction from the multi-disciplinary team, facilitate safe and appropriate post-acute care services integrating patient and family preferences.

Conduct accurate concurrent reviews using InterQual criteria; initiate payer contact, and communicate clinical review data to relevant parties.

Perform a comprehensive review of the medical record to ensure documentation of appropriate level of care status.

Collaborates with the third party payers to anticipate denial of payment and proactively addresses issues contributing to a potential denial.

Refers appropriate cases to social work team members based on established referral criteria.

On a daily basis, identifies cases that fail to meet criteria and promptly reviews the case with the patient's physician to resolve the issue.
Refers unresolved cases to the Director of Care Management and the Associate Medical Director of Utilization Management in a timely manner.

Identifies high-risk patients to promote coordination of services and to prevent avoidable readmissions and/or Emergency Department visits.

Educates staff and physicians about CMS requirements and the Conditions of Participation (CoP). Captures and trends practice, systems, operations, and patient/family issues that result in potentially avoidable days.

Performs other duties as assigned.
Education: Graduate of an accredited school of nursing Bachelor of Science in Nursing is required.
Licensure and Certifications: Current Massachusetts RN license.
Certification in Case Management preferred.
Current American Heart Association Basic Life Support (BLS) Certification [cha013017]

See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Download the
LiveCareer app and find
your dream job anywhere

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Case Manager

Alnylam Pharmaceuticals, Inc.

Posted 2 months ago

VIEW JOBS 9/19/2018 12:00:00 AM 2018-12-18T00:00 Case Manager Overview Alnylam was founded in 2002 on a revolutionary vision and bold mission which remain firmly in place today. We are leading the translation of RNA interference (RNAi) into a new class of innovative medicines with the potential to transform the lives of people with rare genetic, cardio-metabolic, hepatic infectious, and central nervous system diseases with unmet need. Our first medicine, the first-ever RNAi therapeutic, has recently been approved by the FDA in the US for the treatment of the polyneuropathy of hereditary transthyretin-mediated amyloidosis in adults and by the European Medicines Agency in the EU for the treatment of hATTR amyloidosis in adults with stage 1 or stage 2 polyneuropathy. In addition, Alnylam has four investigational medicines in late-stage development. Alnylam is proud to have been recognized as one of The Boston Globe's Top Places to Work in 2015, 2016, and 2017. We are currently building out our US Patient Services team to provide exceptional customer service on all levels. The Case Manager (CM) will be a critical component of the patisiran commercial strategy and will work in close coordination with Field Sales, Field Reimbursement, Patient Education Liaisons and Patient Advocacy Teams to support Alnylam's patient-focused vision of harnessing a revolution in biology for human health®. Reporting to the Director, US Patient Services we seek experienced, passionate, patient-focused individuals committed to improving the lives of those living with hATTR amyloidosis. The CM will be responsible for interfacing with patients, their caregivers, and healthcare providers (HCPs), to facilitate access to patisiran. The CM will work collaboratively with internal and external stakeholders to meet individual patient needs through personalized services and compassionate communication. He/she is responsible for engaging multiple stakeholders in support of getting prescribed patients started on therapy and supporting appropriate compliance. The CM focuses on coordinating various services that individual patients may need and recognizing and addressing reimbursement barriers. The successful candidate must be passionate about science and deeply motivated by the quest of providing support to patients and their families consistent with the company's mission and patient focus. He/she will be responsible for providing a smooth customer interaction from initial intake through supporting continued access to therapy. He/she will help to address the logistical issues impacting treatment. The CM demonstrates understanding of the department business objectives and measures and demonstrates strengths working independently as well as collaboratively within a highly matrixed environment. Additional Information: Flexibility This position allows for the flexibility to work from home up to 3 days per week which will happen after 6 months on the job Once the team is fully staffed we will need to balance business needs with personal flexibility needs; our goal will be to accommodate personal flexibility needs, however, there will be times when attendance in the office is required for certain meetings and we will be forthcoming with those details as we go Summary of Key Responsibilities * Assesses patients' needs and develops action plans to support the initiation of and compliance with treatment with patisiran while coordinating the exchange of appropriate information with internal and external stakeholders * Demonstrates a comprehensive understanding of the reimbursement process, billing/coding nuances, insurance plans, payer trends, patient assistance programs, and related resources * Assists in obtaining insurance approval for patisiran, and works with patients and their caregivers/families, healthcare providers, insurance companies, specialty pharmacies, and others to facilitate ongoing coverage * Understands the resources available in their specific region, and how they can be best employed to support patient care * Identifies patient specific issues, and develops and executes action plans accordingly * Maintains disease, reimbursement and insurance coverage expertise through continuing education and attendance at relevant conferences and other educational opportunities * Educates patients, caregivers, family members, and others regarding available insurance options and limitations, requirements necessary to initiate and maintain treatment, patient services' offerings and relevant disease/product information as appropriate * Fosters collaborative relationships with all internal and external stakeholders including insurance company case managers, specialty pharmacies, home health agencies, infusion site staff and office coordinators * Maintains accurate data on patients, their insurance, coverage approvals, on-going coverage requirements and all interactions with patients and providers and preserves the confidentiality and security of such information * Represents Alnylam at industry conferences and other meetings * Executes all activities and communications in compliance with approved materials and training, including as applicable, talking points and scripts * Complies with all corporate policies, internal procedures and training and applicable laws and industry codes in collaboration with Alnylam Legal, Regulatory and Compliance Qualifications * Bachelor's Degree in Health Care/Social Work/Nursing (or equivalent) * Three to five years recent case management experience in the healthcare or pharmaceutical/biotech industry. Ultra-rare disease experience a plus. * Experience should include but not be limited to home care management, case management review, utilization review, social service support, insurance reimbursement, billing and coding, and patient advocacy * Knowledge of private payer, Medicare, and Medicaid structure, systems, and reimbursement process * Experience and proficiency in working with a Customer Relationship Management System, such as * Possess strong written and verbal communication skills, exceptional listening, critical thinking, problem solving, negotiation and mediation skills * Ability to navigate difficult conversations and handle sensitive issues with opposing opinions * Ability to work independently and manage competing priorities * Experience working in cross-functional teams and effective in influencing without authority * Desire to innovate and work in a fast-paced, energetic environment * Self-starter who is highly passionate about rare disease and Alnylam's core values: * Commitment to People, Innovation, Discovery, Sense of Urgency, Open Culture, and Passion for Excellence. * Ability to travel up to 25%, including weekends Expectations * Clear Alignment with Alnylam Core Values: * Commitment to People * Innovation and Discovery * Sense of Urgency * Open Culture * Passion for Excellence Alnylam Pharmaceuticals is an EEO employer committed to an exciting, diverse, and enriching work environment. #LI-BS1 #LI-BS1 Alnylam Pharmaceuticals, Inc. Cambridge MA

Case Manager

Expired Job

Cambridge Health Alliance