RN - Registered Nurse - RN Case Review Coordinator - Waltham, MA

Looking for RN Case Review Coordinator to start in Waltham, MA. 1 year Contract assignment with the possibility to convert to perm.

ESSENTIAL FUNCTIONS/ KEY RESPONSIBILITY AREAS:
Data Collection Responsible for abiding by all contractual obligations for MassHealth, Medicare, and private reviews conducted. Reviews may consist of but is not limited to: Receive requests for elective inpatient admissions by phone and by fax; set up review process by abstracting and recording key information in paper-based or on-line form. Obtain medical records from queue; for each record, set up review process by abstracting and recording key information in paper-based or on-line form. Use clinical and regulatory criteria to screen each record in timely fashion and validate elements such as level of care, utilization, and billing codes; identify potential quality issues. Perform data abstraction on medical records as assigned. Make recommendations to the department manager regarding modifications of the review process to improve efficiency and productivity.  Handle confidential and private information appropriately, according to confidentiality procedures and HIPPA regulations.

For cases that do not meet criteria, locate an appropriate Physician Reviewer (PR) within contractual timelines using current roster of Physician Reviewers, inform PR on details of the case, and document the Physician Reviewer’s decision as described verbally or in writing. Generates letters and reports as needed per review contract. Respond to inquiries from staff in hospitals and doctors’ offices concerning review procedures.

Qualifications: Current Registered Nurse (RN) license in Massachusetts required. Bachelor of Science, Associates degree or Diploma in nursing. Minimum of three (3) years hospital based clinical nursing experience required or two (2) years recent quality improvement/case management/UR/QA experience in lieu of. Possess basic knowledge of CPT-4 and ICD-9 coding rules.


The Clinical One Case Management Group offers a variety of challenging opportunities at some of the world's most recognized insurance companies and healthcare facilities. Whether you are looking for a permanent assignment, contract work close to home, or 13-26 week travel assignments across the country, Clinical One's Case Management Group has the perfect job for you!

When you join the Clinical One Case Management Group team, you gain access to these great benefits:
Health, Dental & Vision Insurance
Company-Matched 401(k) Plan
Flexible Spending Accounts
Free Unlimited CEU’s
Referral Bonuses
Direct Deposit, Pay Cards & Weekly Pay
Optional Disability Insurance
Free Professional Liability & Workers Compensation Insurance
Free Life & Accidental Death & Dismemberment Insurance

Who's been making career wishes come true for 15 years? We're the ONE!
From our network of offices throughout the US and overseas, Clinical One recruits select healthcare professionals for travel, contract, per diem, case management, and permanent placement positions.

As a preferred vendor at over 1,400 hospitals, Clinical One will provide you with access to thousands of healthcare jobs nationwide. Along with the security of working with a company that has been in business for 15 years and is a member of Vedior, the world's largest provider of specialist staffing, Clinical One also offers extremely competitive pay and one of the best benefit plans in the industry! Our dedicated and friendly staff will work tirelessly to ensure that your assignment and experience with Clinical One go as smoothly as possible. Call a Recruitment Specialist today at 800-919-9100 to learn how we can help make your career wishes come true!

Interested in international placement? Clinical One also offers overseas placement of RN’s, Allied Health Professionals and Social Workers in the United Kingdom, Australia and New Zealand.