Registered Nurse - Case Management

Facility: Plymouth Hospital

Position Description: Contract Guarantee hours= 72 Hours Biweekly on all Assignments these guaranteed hours do not include any on-call time worked

Comments And Notes: BILH COVERSHEET ALL REQUIRED AT TIME OF SUBMISSION --- 8H day shift, rotating weekends. Required: MA license, BLS-AHA, 3-5 years experience in setting, Preferred: ACM, CCM or CMAC -- Duties/Responsibilities: " tReviews admission data to establish the appropriate level of care using Interqual criteria. " tIntegrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient. " tConducts concurrent reviews to determine the continued need for acute care setting, appropriateness and timeliness of treatments/procedures and to optimize the potential for reimbursement. " tCollaborates with the multidisciplinary team to assess and improve the denial management, documentation, and appeals process. " tCollaborates with UR Manager and/or physician advisor regarding cases that do not meet established guidelines for admission or continued stay. " tActs as a liaison between physicians and payers, coordinating peer-to-peer phone calls. " tCollects and compiles data as required. -- NO local travelers will be accepted (cannot reside within 50 mi from the facility) Start date: ASAP, biweekly starts NM to interview and offer-- Please provide dates and times available for interview at time of submission ALL RTO REQUESTS MUST BE PRESENTED AT TIME OF SUB Travelers who have worked for Beth Israel Lahey Health as travel, perm or per diem within the last year will not be accepted - MUST be separated from facility for one year to be considered