Nursing Jobs in Reading, MA
$195,200 - $341,600 / year
Job Summary: The Medical Director is responsible for supporting staff by providing training, clinical consultation, and clinical case review for members. Essential Functions: Provide prior authorization medical reviews, consultation and clinical review services Participate in peer-to-peer discussions Provide provider education, training, data sharing, performance evaluations and orientation to the plan Conduct clinical reviews for designated CareSource members as requested Provide physician review for clinical appeals cases Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns Participate in development of policies and procedures Participates in quality improvement initiatives, case management activities and member safety activities (i.e. incident management Provide cross-coverage for other Medical Directors and/or markets, as needed Oversight and quality improvement activities associated with case management activities Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards Participate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives Collaborate with market/product leaders to help define market strategy Community collaborative participation Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs Perform any other job related instructions, as requested Education and Experience: Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required Successful completion of a residency training program, preferably in primary care is required Minimum of five (5) years of clinical practice experience is required Managed care medical review/medical director experience is preferred Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is preferred Competencies, Knowledge and Skills: Basic Microsoft Word skills Excellent communication skills, both written and oral Ability to work well independently and within a team environment Ability to create strong relationships with Providers and Members High ethical standards Attention to detail Critical listening and systematic thinking skills Ability to maintain confidentiality and act in the company’s best interest Ability to act with diplomacy and sensitivity to cultural diversity Decision making/problem solving skills Conflict resolution skills Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served Licensure and Certification: Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required Board Certification, preferably in primary care specialty is required Re-certification, as required by specialty board, must be maintained (exceptions may be granted by Chief Medical Officer) MCG Certification is required or must be obtained within six (6) months of hire Working Conditions: General office environment; may be required to sit or stand for extended periods of time May be required to work evenings/weekends May be required to travel to fulfill duties of position Compensation Range: $195,200.00 - $341,600.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-SW2 $195,200 - $341,600 / year
Job Summary: The Medical Director is responsible for supporting staff by providing training, clinical consultation, and clinical case review for members. Essential Functions: Provide prior authorization medical reviews, consultation and clinical review services Participate in peer-to-peer discussions Provide provider education, training, data sharing, performance evaluations and orientation to the plan Conduct clinical reviews for designated CareSource members as requested Provide physician review for clinical appeals cases Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns Participate in development of policies and procedures Participates in quality improvement initiatives, case management activities and member safety activities (i.e. incident management Provide cross-coverage for other Medical Directors and/or markets, as needed Oversight and quality improvement activities associated with case management activities Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards Participate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives Collaborate with market/product leaders to help define market strategy Community collaborative participation Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs Perform any other job related instructions, as requested Education and Experience: Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required Successful completion of a residency training program, preferably in primary care is required Minimum of five (5) years of clinical practice experience is required Managed care medical review/medical director experience is preferred Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is preferred Competencies, Knowledge and Skills: Basic Microsoft Word skills Excellent communication skills, both written and oral Ability to work well independently and within a team environment Ability to create strong relationships with Providers and Members High ethical standards Attention to detail Critical listening and systematic thinking skills Ability to maintain confidentiality and act in the company’s best interest Ability to act with diplomacy and sensitivity to cultural diversity Decision making/problem solving skills Conflict resolution skills Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served Licensure and Certification: Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required Board Certification, preferably in primary care specialty is required Re-certification, as required by specialty board, must be maintained (exceptions may be granted by Chief Medical Officer) MCG Certification is required or must be obtained within six (6) months of hire Working Conditions: General office environment; may be required to sit or stand for extended periods of time May be required to work evenings/weekends May be required to travel to fulfill duties of position Compensation Range: $195,200.00 - $341,600.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-SW2 
$120,000 - $130,000 / year
Overview Dialysis Clinic, Inc. is recruiting top talent interested in supporting our nonprofit mission to prioritize individualized care for hospitalized patients facing acute kidney injury and chronic kidney disease. Our mission states “the care of the patient is our reason for existence,” and our dedicated team embodies our sole purpose during every patient interaction. We seek motivated, compassionate individuals to provide top-notch patient care and offer paid training, competitive pay, outstanding benefits and a positive, mission-driven culture. Join DCI today to build relationships and gain fulfillment caring for dialysis patients in an acute care environment. The Hospital Services Nurse Manager leads our acute dialysis unit in performing high quality patient care while collaborating with physicians and hospital staff to enhance partnerships for our local Hospital Services program in the acute hemodialysis unit. Schedule: Fulltime position working weekdays with weekend call, set upon hiring Compensation: Pay range from$120,000 to $130,000 depending on nursing and dialysis experience; experience preferred. $10,000 Sign On Bonus Benefits: New nurse manager training program Comprehensive medical, dental and vision benefits Life and long-term disability insurance provided at no additional expense to employee Paid time off (PTO) including holidays Extended Sick Bank (ESB) in addition to PTO – paid time for doctor appointments, sickness or medical leave Retirement plans with $.50 of each contributed dollar matched for eligible employees, up to 8 percent Education reimbursement Employee assistance program Wellness program Among others Responsibilities What You Can Expect: Liaison between hospital administration and DCI area leadership Primary contact to the medical director and openly communicates with all nephrologists regarding services and care provided Evaluate and make recommendations to physicians regarding patient care Supervise nursing activities to ensure patient care is delivered as directed Collaborate with local DCI nurse educator to deploy training and continuing education for all staff members Mentor DCI Hospital Services staff Oversee nursing care documentation, including medication and dialysis adjustments Work with chief equipment technician regarding dialysis equipment maintenance and water treatment practices per industry standards Communicate with hospital discharge planners, case managers and outpatient dialysis units to ensure smooth care transitions Manage general nursing budget, making equipment and supply recommendations Maintain working knowledge of industry standards related to renal replacement therapy in hospitals, including ESRD and AKI concepts/principles, regulatory and accreditation standards Participate in DCI risk management and Quality Assessment Performance Improvement (QAPI) programs, including required audits and regular attendance at DCI QAPI and governing body meetings Contribute to hospital quality management and infection control departments by providing requested information and attending meetings with hospital liaison Qualifications Successful Candidates Bring: Excellent communication skills Demonstrated clinical proficiency Ability to multitask and prioritize projects Desire to collaborate with care teams Ability to problem solve Customer service mindset in communicating with patients, team members and partner hospital Education/Training: Current MA RN license required Accredited nursing degree required Six months’ dialysis nursing experience in a hospital setting required; Twelve months’ preferred Critical care nursing and supervisory experience preferred DCI’s Differentiator: Since opening the first clinic 50 years ago in Nashville, Tenn., our Dialysis Clinic, Inc. family has grown to be the nation’s largest nonprofit dialysis provider with more than 270 locations in 30 states, serving nearly 14,000 patients each day. DCI invests in our care teams and funds research to further kidney care and treatment options. DCI prioritizes a holistic approach and offers hemodialysis, home dialysis and peritoneal dialysis treatment options. We empower patients to live meaningful and productive lives while also delivering high quality kidney care, saving lives and reducing hospitalizations. Learn more about DCI and see if we’re hiring in a clinic near you! www.dciinc.jobs DCI is committed to building a diverse and inclusive organization. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or veteran status. DCI is a federal contractor and an Equal Opportunity/Affirmative Action Employer-Veterans/Individuals with Disabilities. If you are having difficulty using the online application system or would like to request other accommodations or application methods, please contact Doug Patterson at Accommodations@dciinc.org or 615-327-3061. Once a request has been made, DCI will initiate a discussion with you about your needs and whether an accommodation can be provided. DCI is committed to providing such accommodations where possible. For more information about equal opportunity please see: https://www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf; https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf; https://www.dol.gov/ofccp/pdf/pay-transp_formattedESQA508c.pdf; and https://www.nlrb.gov/sites/default/files/attachments/basic-page/node-3788/employeerightsposter-8-5x11.pdf. Security Roles and Responsibilities can be reviewed at: https://www.dciinc.org/security-roles 
