At Boston Children's Hospital, the quality of our care - and our inclusive hospital working environment - lies in the diversity of our people. With patients from local communities and 160 countries around the world, we're committed to reflecting the spectrum of their cultures, while opening doors of opportunity for our team. Here, different talents pursue common goals. Voices are heard and ideas are shared. Join us, and discover how your unique contributions can change lives. Yours included.
The Case Manager will be responsible for:
Focusing on level of care and appropriate reimbursement.
Developing a process from initial scheduling to discharge, to ensure level of care assignments are as accurate as possible.
Conduct clinical appeals if a case is denied inpatient level (prior to admission).
Connecting with UM Case Manager on the concurrent side for any questions of consistency.
Monitoring payer response times in relation to contractual agreements on turnaround in order to ensure appropriate time to conduct appeals.
Creating templates for schedulers and physicians to use to help with peer to peer process.
Conducting proactive education on the importance of level of care.
Suggesting ISD solutions for improvement of communication (e.g. SPS options, streamlining language)
Leading physician education efforts to inform level of care decisions
Serving as point person for clinical staff who have questions about level of care distinctions
To qualify, you must have:
A BSN required, a Master's in a related Healthcare field or certification is a plus.
Minimum 3-5 years of related Case Management or clinical experience.
The ability to work 40 hours per week, Monday through Friday, remotely, yet must still live within the immediate Boston/ New England area.
Please note: During a public health emergency, individuals in this role may be expected to take on additional duties to respond to organizational needs.
Boston Children's Hospital offers competitive compensation and unmatched benefits, including affordable health, vision and dental insurance, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition Reimbursement, and discounted rates on T-passes (50% off). Discover your best.
Boston Children's Hospital is an Equal Opportunity / Affirmative Action Employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability.
Internal Number: 3157280
About Boston Children's Hospital
Boston Children's Hospital is a 395-bed comprehensive center for pediatric health care. As one of the largest pediatric medical centers in the United States, Children's offers a complete range of health care services for children from birth through 21 years of age.