Nursing Jobs in North End, MA
$87,360 - $98,603.60 / year
Job Profile Summary This role focuses on providing professional and nonprofessional nursing care services in accordance with physician orders. In addition, this role focuses on performing the following Home Care Nurse duties: Assesses, plans, implements, and evaluates the care needs of a designated group of patients or provides nursing care and identified clinical support tasks within the scope of practice for achievement of the patient’s plan of care as directed. Provides professional nursing care to patients. Requires a nursing license. A professional individual contributor role that may direct the work of other lower level professionals or manage processes and programs. The majority of time is spent overseeing the design, implementation or delivery of processes, programs and policies using specialized knowledge and skills typically acquired through advanced education. An experienced level role that applies practical knowledge of job area typically obtained through advanced education and work experience. Works independently with general supervision, problems faced are difficult but typically not complex, and may influence others within the job area through explanation of facts, policies and practices. Job Overview The position is a member of the hospice staff who determines appropriateness of referrals, coordinates and conducts pre-admission activities, completes admission when determined hospice appropriate , monitors inpatient care at contracted hospitals, performs in-service training and community education activities. This position performs duties in a variety of settings including 6patient’s home, acute care setting, skilled nursing facility or assisted living. Job Description Minimum Qualifications : 1. Massachusetts RN Licensure. 2. Hospice and/or end of life experience required . Location: Lowell, MA and surrounding areas Hours: Full-Time, 40hrs/week, Weekend/Holiday Commitment. Duties and Responsibilities : The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list . Other duties and responsibilities may be assigned. 1. Describes and explains hospice services to a potential patient and/or family member and elicits responses to questions regarding attitude towards hospice care, evaluates physical and psycho/social/emotional status, in order to put the patient and family at ease about choosing hospice and fully inform them about the program. 2. Works with hospice intake and eligibility department to verify insurance reimbursement for each referred patient and document in EMR. 3. Reviews and explains to patient and/or family about insurance coverage and financial obligations, using knowledge of hospice fees, costs and reimbursement sources. Escalates to referral management director and/or referral manager, in circumstances of potential admission where reimbursement sources appear not to cover hospice fees, to ascertain whether reduce fee or free care may be offered. 4. Introduces and explains benefits of hospice care and familiarizes decision makers with characteristics and needs that indicate an appropriate hospice referral. Presents the advantage of the hospice Medicare/Medicaid benefits to referral sources. 5. Thoroughly understands the Medicare/Medicaid hospice benefit, the Medicare home health benefit, the Medicare/Medicaid long term benefit and the Medicare HMO benefit. 6. Documents a narrative note in the EMR summarizing pertinent physical and psychosocial information from the hospital record and/or from the physician and patient/family assessment. Reviews referred patient’s history, medical status, and prognosis to determine eligibility for hospice services relying on the knowledge of hospital procedure and hospice admission criteria. 7. Completes the patient/family admission packet, including obtaining signed Notice of Election of Hospice Benefit (NOE), admission forms from the patient, family, referral source and the attending physician. Uploading completed admission documents electronically to medical records for them to complete their process. 8. Communicates information from Comprehensive Assessment to TMCAH CMO, hospice physician or TMCAH covering NP. Documents results and performs warm hand off to team. 9. Communicates NTUC to appropriate staff and managers. Documents reason and continuation of care measures implemented. 10. Promotes hospice services, to ensure appropriate referrals to hospice program, may perform liaison activities centered in the acute care setting, which include but not limited to, case conferences to case managers, discharge planners, physicians, other health care providers and referral sources. 11. Works with TMCAH liaison and intake staff to ensure ease of referral, as well as a rapid response to the referral source. 12. Evaluates and compares information, regarding referred patient to hospice criteria. Consult with either the referral management director, referral manager, CMO, or hospice physician when an admission is questionable. 13. Communicates on a regular basis with patient, family, referral source, hospice intake or liaison staff, to ensure continuity of care and adherence to the hospice plan of care. 14. Develops opportunities for and conducts in-service presentations in health care facilities regarding hospice care and the indications for a hospice referral. 15. Promotes knowledge and awareness of the hospice program and its services to the professional community. 16. Identifies potential new referral sources. 17. Joins approved professional organizations and other groups which include key decision makers in the care of terminally ill patients. 18. Assists with public relations activities to promote community awareness of Hospice services . Includes activities during National Hospice Month. 19. Reports Compliance concerns to the CEO or Chief Compliance Officer when applicable. 20. Ensures compliance within guidelines set forth by regulatory agencies (DPH, ERISA etc.) and demonstrates compliance with Tufts Medicine Care at Home policies and procedures. 21. Gather s all pertinent information necessary for admission. Physical Requirements : 1. While performing the duties of this job, the employee is required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; taste or smell. 2. The employee must regularly lift and/or move 25 lbs and occasionally lift and/or move up to 100 lbs. 3. The employee in this position frequently communicates internally and externally. 4. Must be able to exchange accurate information via phone, email and/or in person. 5. Specific vision abilities apply i ncluding close vision, distance vision and ability to adjust focus. 6. Noise level in the work environment is usually moderate. 7. May be e xposed to weather conditions prevalent at the time. Skills & Abilities: 1. Ability to effectively communicate with patients, families, physicians, and healthcare team. 2. Ability to be organized and systematic. 3. Knowledge of the home care practice setting. What We Offer Competitive salaries & benefits Medical, Dental and Vision benefits start day one 403(b) retirement with company match Tuition reimbursement and continuing education support - Access to MedBridge for PT CEUs and licensure/certification support, reinforcing our commitment to ongoing clinical development. Opportunities for career growth Fleet car program - A unique offering that reduces personal vehicle burden and supports clinicians in the field. Industry-Leading Safety Program – A one-of-a-kind Workplace Safety & Violence Prevention role dedicated to proactively addressing increasing safety concerns in healthcare settings. This program includes: AVADE de-escalation and self-safety training InvisaWear GPS-enabled safety devices Escort services to ensure staff safety in the field About Care at Home: Tufts Medicine Care at Home is a proud member of Tufts Medicine, a health system that is rethinking how academic and community centers, local and national businesses, and technology and service innovators can all work together. So that clinicians can deliver expert care where it’s needed most and so that we can bring wellness back to health care, one person at a time. About Tufts Medicine A healthcare system that works Tufts Medicine is more than a health system — we’re a community that empowers people to live their best lives by reimagining healthcare, advancing knowledge and pioneering discovery. Every team member plays an integral role in realizing our vision of creating the most equitable and frictionless healthcare experience in the world. Here, you’ll join an enthusiastic community that champions your growth and receive generous benefits to support you and your family’s well-being. Tufts Medicine is an equal opportunity employer At Tufts Medicine, we want every individual to feel valued for the skills and experience they bring. Our compensation philosophy is designed to offer fair, competitive pay that attracts, retains, and motivates highly talented individuals, while rewarding the important work you do every day. The base pay ranges reflect the minimum qualifications for the role. Individual offers are determined using a comprehensive approach that considers relevant experience, certifications, education, skills, and internal equity to ensure compensation is fair, consistent, and aligned with our business goals. Beyond base pay, Tufts Medicine provides a comprehensive Total Rewards package that supports your health, financial security, and career growth—one of the many ways we invest in you so you can thrive both at work and outside of it. Pay Range : $87,360.00 - $98,603.60 
$90,000 - $107,000 / year
Site: Mass General Brigham Health Plan Holding Company, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary Given equity, this position will pay somewhere between $90,000 to $107,000 annually. Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more. The UM Nurse will support network adequacy review and authorization activities for members enrolled in ACO, HMO, and EPO products who require planned inpatient or outpatient services from out-of-network providers. Utilizing clinical knowledge, the UM Nurse will review prior authorization requests, assess medical necessity and benefit coverage, render approval decisions within scope, determine when physician review is required, and complete determinations following physician review. The ideal candidate will have prior authorization experience in a managed care setting and possess strong commercial health plan knowledge. Essential Functions: • Expertise in clinical review for prospective, concurrent, retrospective utilization management reviews utilizing Interqual ®, company policies and procedures, and other resources as determined by review, including physician reviews as needed for all lines of business as per departmental needs • Review authorization requests for medical services, including making initial eligibility and coverage determinations, screening for medical necessity appropriateness, determining if additional information is required, and referral to correct programs within Mass General Brigham Health Plan as needed. • Manage incoming requests for procedures and services including patient medical records and related clinical information. • Strong working knowledge of commercial, self-insured, fully insured, and limited network plans. • Adherence to program, departmental, and organizational performance metrics, including productivity. • Excellent verbal and written communication skills. • Excellent problem-solving and customer service skills. • Would need to be available for “on call” for a minimum of once per month with the possibility of that increasing depending on staff availability; Approximately 6 months after hire. • Must be self-directed and highly motivated with an ability to multitask. • Develop and maintain effective working relationships with internal and external customers • Hold self and others accountable to meet commitments. • Sound decision-making and time management skills. • Proactive in areas of professional development, personally and for the department. • Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise. • Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization. • Proficient with Microsoft Word, Excel, Outlook, McKesson InterQual ®, Outlook, SharePoint, PC based operating system, and web-based phone system. Qualifications Education Associate's Degree Nursing required or Bachelor's Degree Nursing preferred Licenses and Credentials Massachusetts Registered Nurse (RN) license required Experience At least 2-3 years of utilization review experience is highly preferred Experience using Interqual or Milliman is highly preferred At least 1-2 years of experience in a payer setting is highly preferred At least 1-2 years of experience in an acute care setting is highly preferred Knowledge, Skills, and Abilities Demonstrate Mass General Brigham Health Plan’s core brand principles of always listening, challenging conventions, and providing value Strong aptitude for technology-based solutions. Embrace opportunities to take the complexity out of how we work and what we deliver. Listen to our constituents, learn, and act quickly in our ongoing pursuit of meaningful innovation Current in healthcare trends. Ability to inject energy, when and where it’s needed. Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback. Be accountable for delivering high-quality work. Act with a clear sense of ownership. Bring fresh ideas forward by actively listening to and working with employees and the people we serve. Communicate respectfully and professionally with colleagues Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback. Knowledge, Skills, and Abilities Demonstrate Mass General Brigham Health Plan’s core brand principles of always listening, challenging conventions, and providing value Strong aptitude for technology-based solutions. Embrace opportunities to take the complexity out of how we work and what we deliver. Listen to our constituents, learn, and act quickly in our ongoing pursuit of meaningful innovation Current in healthcare trends. Ability to inject energy, when and where it’s needed. Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback. Be accountable for delivering high-quality work. Act with a clear sense of ownership. Bring fresh ideas forward by actively listening to and working with employees and the people we serve. Communicate respectfully and professionally with colleagues Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback. Additional Job Details (if applicable) Working Conditions Would need to be available for “on call” for a minimum of once per month with the possibility of that increasing depending on staff availability; Approximately 6 months after hire. This is a remote role with occasional onsite team meetings in Somerville, MA. Monday through Friday, eastern business hours required Remote workdays require a stable, secure, quiet, and HIPAA-compliant workspace. This will be confirmed via Microsoft Teams video for all employees Given equity, this position will pay somewhere between $90,000 to $107,000 annually. Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $58,656.00 - $142,448.80/Annual Grade 98TEMP At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: 8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline. 
