Advantis Medical is excited to announce an outstanding opportunity for a Case Manager in Jamaica Plain, MA. This rewarding travel contract position operates on a 3 shifts per week schedule with a contract duration of 10 weeks. With us, you'll enjoy a superior pay and benefits package, along with our personalized service that has ranked us the #1 travel nurse agency. As a Joint-Commission-certified agency, we promise a seamless and stress-free experience.
• Strong knowledge of Medicare regulatory requirements including Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs)
• Strong knowledge of Medicaid/MassHealth regulatory requirements
• Expertise in clinical review for prospective, concurrent, retrospective utilization management reviews utilizing Interqual, company policies and procedures, and other resources as determined by review, including physician reviews as needed for all lines of business as per departmental needs
• Review authorization requests for medical services, including making initial eligibility and coverage determinations, screening for medical necessity appropriateness, determining if additional information is required, and referral to correct programs within Mass General Brigham Health Plan as needed.
• Manage incoming requests for procedures and services including patient medical records and related clinical information.
• Adherence to program, departmental and organizational performance metrics including productivity.
• Excellent verbal and written communication skills.
• Excellent problem solving and customer service skills.
• Must be self directed and highly motivated with an ability to multi-task.
• Develop and maintain effective working relationships with internal and external customers
• Hold self and others accountable to meet commitments.
• Sound decision making and time management skills.
• Proactive in areas of professional development personally and for the department.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle.
• Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
• Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
• Proficient with Microsoft Word, Excel, Outlook, McKesson InterQual, Outlook, SharePoint, PC based operating system, and web-based phone system.
• Experience with clinical applications/systems.
• Other duties as assigned with or without accommodation.
• Work is normally performed in a typical office work environment.
• Able to stand and sit for periods of time as needed to perform work-related functions
• Ability to use a laptop/computer, manual dexterity, headset use
• License/Certificate Verification
• Personal Health History: COVID-19 Vaccine, MMR, Hepatitis B, Influenza Vaccine, TB Test, Health Statement, Varicella, Tdap
• Professional: MGB Criminal Background Check, Massachusetts CORI, Resume, Employment Eligibility Statement, Respirator Fit Questionnaire, References, Confirmation of Assignment/POI Form, Education Verification, SSN Trace, National Sex Offender Check, OIG/GSA and Mass Health databases
• Checklist/Testing: MGB Skills Checklist
• Personal Health History: Positive PPD- Negative Chest X-Ray
• Order Requisition Reason Name: Short Staffed/Open FTEs
Take the next step in your nursing career with Advantis Medical and unlock a world of possibilities. Apply now and join our team of dedicated professionals! Jobs fill quickly, so don't miss out on this amazing opportunity.
Advantis Medical is ranked #1 by travel clinicians because of our relentless focus on matching our travel clinicians with their next dream assignment. You can choose to work with one of our Pro Recruiters and receive The Gold standard in clinician care while they do all the work for you, or search one of our thousands of jobs and apply directly on our job pages. We take pride in helping travelers find their dream assignment by eliminating the stress and hassle of a job search.
Standard in Clinician Care
We treat every clinician like GOLD and help create a stress-free process as you embark on your new adventure. Experience our gold standard level of service as our committed team assists you with your travel and housing arrangements, guides you through credentialing and onboarding so you can quickly start your next dream adventure.
- $500 Referral Bonuses
- Comprehensive Medical, Dental, & Vision and 401(k) plans
- Relocation and Travel Reimbursement
- Weekly Direct Deposit
- With the co-pilot service, you're guaranteed continuous support
Jamaica Plain, Massachusetts (MA), radiates with a unique cultural vibe that will captivate travel nurses and allied health professionals. Its vibrant community offers a thriving food scene and endless cultural attractions, including Jamaica Pond and Arnold Arboretum. Embrace the city's delightful climate, enjoying warm summers and picturesque autumn foliage. Within close proximity, explore the bustling nearby cities of Boston and Cambridge. Begin an exceptional career with Advantis Medical here, where exploration, adventure, and professional growth intertwine seamlessly in this exciting and inviting locale.