Case Manager, Per Diem

Exemption Status:

Hiring Range:

Please note that the final offer may vary within this range based on a candidate's experience, skills, qualifications, and internal equity considerations.

Schedule Details:

Scheduled Hours:

Shift:

Hours:

Cost Center:

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

I. Major Responsibilities:
1. Maintains responsibility for the coordination and submission of appeals to third party payers within allotted timeframes to prevent fiscal penalties
2. Is the key contact person for all Medicare RAC denials and processes each denial following the established framework.
3. Meets with the Case Managers to review the medical record to gather missing supportive documentation to strengthen the appeals process.
4. Maintains dialogue with payers about disputed claims and maintains documentation of ongoing efforts for each disputed claim.
5. Assists in the writing of draft appeal letters and prepares and edits the final documents prior to submission to the third-party payer.

II. Position Qualifications:

Licensure/Certification/Education:
Required:
1. Current Massachusetts licensure of RN
2. Graduate of an accredited school of nursing.
3. BS required

Experience/Skills:
Required:
1. Minimum 7 -10 years relevant experience including UR/ Case management in the acute care setting.
2. Expert working knowledge of all applicable level of care criteria applications-both written and electronic
3. Expert in InterQual criteria-maintains level of expertise to be hospital wide trainer
4. Comprehensive proficiency the case management role, including direct patient interaction and care planning
5. Expert knowledge of current reimbursement models: Commercial, managed care, Medicare, Public Assistance.
6. Excellent interpersonal communication and negotiation skills with physicians, payers and peers.
7. Ability to engage and educate colleagues regarding utilization, regulatory and compliance issues.
8. Ability to work independently with excellent organizational skills and make decisions objectively.
9. Strong analytic, data management and computer skills.
10. Technical writing ability for appeal letters and reports.
11. Analytical abilities to aggregate and report findings and to assist in obtaining solutions to problems.
12. Must be able to work independently and prioritize work.
13. Must be able to manage multiple priorities.

Preferred:
1. Certification in Case Management, Billing/Coding preferred

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.