Overview
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 client's 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.
ResponsibilitiesESSENTIAL FUNCTIONS:
REQUIRED QUALIFICATIONS:
PREFERRED QUALIFICATIONS:
Location - Need to be in proximity to Southeast Cape Cod Area
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