What are the responsibilities and job description for the Nurse Reviewer II - Medical Necessity position at University of Massachusetts Medical School?
About the Role:
We are seeking a skilled Nurse Reviewer II to provide administrative case management as part of the Community Case Management Program. This position involves authorization, coordination, and facilitation of community long-term care services for program Members.
Key Accountabilities:
- Serve as the clinical manager for an assigned caseload of Members.
- Contribute as an active member of a multidisciplinary team to assess, plan, organize, review, and evaluate the care needs of Members requiring healthcare services.
- Conduct on-site reviews and assessments of Members' community long-term care needs to determine medical necessity and clinical eligibility for Community Case Management and Continuous Skilled Nursing Services.
- Determine and authorize services for Members in accordance with program guidelines and regulations.
- Prepare and implement Member service records.
