Nurse Reviewer II-Case Mgt (Home Based with Client Visits)

Nurse Reviewer II-Case Mgt (Home Based with Client Visits)

Minimum Salary

US-MA-Westborough

Job Location

1 week ago (11 / 13 / 2025 4 : 26 PM)

Requisition Number

2025-48959

# of Openings

Posted Date

Day

Shift

Exempt

Overview

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.

You'll 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.

Responsibilities

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.

Qualifications

REQUIRED QUALIFICATIONS :

PREFERRED QUALIFICATIONS :

Additional Information

Why Join Us

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

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