RN Case Review Coordinator - Per Diem - Faulkner

Brigham & Women's Faulkner Hospital; Pelham; On-site; CAD 60,000 - 95,000; Part time

Job summary

An established industry player is seeking a dedicated Case Review Coordinator to enhance patient care and facilitate smooth transitions post-discharge. This role emphasizes critical skills in Utilization Review and Case Management, ensuring patients receive the appropriate level of care. Join a team committed to excellence in healthcare, where your contributions directly impact patient outcomes and community health. If you are passionate about making a difference and thrive in a collaborative environment, this position offers a fulfilling career path in a supportive and dynamic setting.

Qualifications

• 3 years of Utilization Review and Case Management experience preferred.
• 5 years of Acute Care Nursing required or 6 or more years preferred.

Responsibilities

• Conduct audits and appeals, including peer-to-peer processes.
• Collaborate with patients and interdisciplinary teams for discharge needs.

Skills

Utilization Review

Case Management

Acute Care Nursing

Critical Thinking

Negotiation Skills

Effective Communication

Basic Computer Skills

Education

Bachelor's Degree in Nursing

Tools

ECare

Excel

Word

Job description

Schedule: Per Diem

Why YOU should be our newest Case Review Coordinator:

Perform the six essential activities of Case Management: Assessment, Planning, Implementation, Coordination, Monitoring, and Reassessing through the continuum of care to facilitate a safe, cost-effective transition post-discharge.

Conduct all aspects of audits and appeals, including the peer-to-peer process.

Perform utilization review to evaluate the appropriate level of care and fax all insurance reviews timely to prevent denials.

Collaborate with patients, families, and interdisciplinary teams to assess discharge needs.

Interact with various third-party payers daily.

Review for Observation status and make necessary changes.

Minimum Qualifications:

• Bachelor's Degree in Nursing required
• 3 years of Utilization Review and Case Management experience preferred or 4 or more years of experience
• 5 years of Acute Care Nursing required or 6 or more years preferred
• Adherence to all I C.A.R.E. Standards
• Knowledge and skills to work with various age groups for safe discharge planning
• Ability to care for patients despite psychosocial, educational, or physical disabilities
• Basic computer skills, experience with Excel and Word, good computation skills
• Effective communication within diverse communities
• Competent in Utilization Review, appeals, peer-to-peer process, and Case Management
• Critical thinking and solution-driven approach
• Strong negotiation skills with insurance companies and third-party payers
• Timely discharge planning in the appropriate environment
• Proficient in the use of ECare

Who We Are:

Brigham and Women's Faulkner Hospital is an affiliate of Mass General Brigham, dedicated to patient care, research, teaching, and community service.

Located in Jamaica Plain, our 171-bed non-profit, community teaching hospital was founded in 1900. We offer comprehensive care across various specialties and are Magnet designated, a recognition held by fewer than 9% of US hospitals.

We believe everyone should have the opportunity to lead a healthy life. From pioneering treatments to training future providers, our patients are at the heart of everything we do. Join us if you seek more than just a career—call it better care, call it home.

Brigham and Women's Faulkner Hospital is an Equal Opportunity Employer. We embrace diversity and are committed to providing reasonable accommodations for individuals with disabilities throughout the employment process and job functions.