Case Review Coordinator - Remote

Overview

The Case Review Coordinator at Brigham and Women's Faulkner Hospital plays a crucial role in facilitating safe and cost-effective transitions for patients post-discharge through comprehensive case management activities.

In Short

• Perform essential activities of Case Management: Assessment, Planning, Implementation, Coordination, Monitoring, and Reassessing.
• Conduct audits and appeals, including peer-to-peer processes.
• Evaluate appropriate levels of care through utilization review.
• Collaborate with patients, families, and interdisciplinary teams for discharge needs.
• Interact with third-party payers daily.
• Review Observation status and make necessary changes.
• Adhere to I C.A.R.E. Standards.
• Demonstrate knowledge and skills to work with diverse age groups.
• Utilize critical thinking and negotiation skills with insurance companies.
• Proficient in ECare and discharge planning.

Requirements

• Bachelor's Degree in Nursing required.
• 3-4 years of Utilization Review and Case Management experience preferred.
• 5-6 years of Acute Care Nursing experience required.
• Basic computer skills, including Excel and Word.
• Ability to communicate within a diverse community.
• Competent in Utilization Review and Case Management.
• Good negotiation skills with insurance companies.
• Ability to provide care despite psychosocial or physical disabilities.
• Critical thinking skills in all interactions.
• Experience with discharge planning.

Benefits

• Opportunity to work in a diverse and inclusive environment.
• Engagement in meaningful patient care and community service.
• Access to professional development and training opportunities.
• Work in a Magnet designated hospital.
• Be part of a passionate and welcoming community.