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Nurse Reviewer II-Case Mgt (Home Based with Client Visits)
Job Number: 2025-48959
Category: Healthcare
Location: Westborough, MA
Shift: Day
Exempt/Non-Exempt: Exempt
Business Unit: ForHealth Consulting
Department: ForHealth Consulting - Community Service - W401950
Job Type: Full-Time
Num. Openings: 1
Post Date: Nov. 13, 2025
Work Location: 100% Remote
Salary Minimum: USD $80,000.00/Yr.
Salary Maximum: USD $95,000.00/Yr.

POSITION SUMMARY: 

ForHealth Consulting at UMass Chan Medical School is seeking a detail-oriented Nurse Reviewer II with experience caring for individuals with complex medical needs to join our Community Case Management Program. In this role, you will manage a caseload of members, ensuring they receive the long-term services and supports (LTSS) they need to thrive in the community. This position combines the flexibility of remote work with meaningful field interactions through home and site visits.

Youll play a key role on a multidisciplinary team - assessing, planning, coordinating, and authorizing care for individuals with complex medical needs, while collaborating closely with providers, state agencies, and other healthcare partners to ensure continuity and quality of care.

ESSENTIAL FUNCTIONS

  • Serve as the clinical case manager for an assigned caseload of members.
  • Conduct on-site assessments to determine medical necessity and clinical eligibility for Community Case Management and Continuous Skilled Nursing Services.
  • Authorize, coordinate, and monitor long-term care services in accordance with program guidelines.
  • Prepare and maintain comprehensive service records and documentation in compliance with program and HIPAA requirements.
  • Collaborate with providers, hospitals, and agencies to foster integrated care delivery.
  • Review service plans and modify as needed based on member progress or changing needs.
  • Participate in performance improvement initiatives and support onboarding of new clinical staff.

REQUIRED QUALIFICATIONS:

  • RN licensed to practice in Massachusetts
  • 5-7 years of work experience with at least 3 recent years providing direct service or case management to the pediatric, young adult, or adult medically complex population
  • Ability to travel statewide to Member homes and service providers places of business
  • Experience with Office Application and database
  • Valid Drivers license required

PREFERRED QUALIFICATIONS:

  • Experience with home care
  • Knowledge of applicable state regulations
  • Experience with prior authorization and/or eligibility determinations
  • Experience with the care of medically complex individuals

Why Join Us

At ForHealth Consulting, part of UMass Chan Medical School, we are dedicated to advancing health and well-being across Massachusetts communities. Youll be part of a mission-driven organization that values collaboration, innovation, and compassion in care management.

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Posting Disclaimer:
This job posting outlines the primary responsibilities and qualifications for the role but is not intended to be an exhaustive list. Duties and expectations may evolve in response to the needs of the department and the broader institution.

In alignment with our commitment to pay transparency, the base salary range for this position is listed above (exclusive of benefits and retirement). At UMass Chan Medical School, final base salary offers are determined based on a combination of factors, including your skills, education, and relevant experience. We also consider internal equity to ensure fair and consistent compensation across our teams.

Please note that the range provided reflects the full base salary range for this position. Offers are typically made within the midrange to allow for future growth and development within the role.

In addition to base pay, UMass Chan offers a comprehensive Total Rewards package, which includes paid time off, medical, dental, and vision coverage, and participation in a 401(a)-retirement plan, with the option to contribute to a voluntary 403(b) plan.

UMass Chan welcomes all qualified applicants and complies with all state and federal anti-discrimination laws.

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