
POSITION SUMMARY:
FOR MA POSITIONS:
Under the general supervision of the Associate Director, or designee, the Nurse Reviewer II is responsible for assessing clinical eligibility, prior authorizations and providing interval case consultation by reviewing medical records, assessing the clients needs, and providing resource support for program participants/applicants. This position ensures that eligible individuals are referred to and receive appropriate services based on medical necessity determinations and program/waiver regulations.
FOR NH POSITIONS:
Under the general supervision of the Associate Director, or designee, the Nurse Reviewer II is responsible for assessing clinical eligibility, including nursing facility level of care determinations and pre-admission screening resident reviews by conducting face to face evaluation and reviewing nursing facility medical records. This position ensures that eligible individuals are referred to and receive appropriate services based on medical necessity determinations and program regulations. This position is based in New Hampshire.
ESSENTIAL FUNCTIONS:
REQUIRED QUALIFICATIONS:
PREFERRED QUALIFICATIONS:
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UMass Chan Medical School was among 23 companies that stood out as 2023 “DEI champions,” according to The Boston Globe.