Jobloria
Nurse Reviewer II-Case Mgt
UMass Medical School
Location : Westborough,MA
Job Type : Full Time
Salary : $95,000.00/Yr
Date Posted : 2 December 2025
Job Number: 2025-48959
Category:Healthcare
Location: Westborough, MA
Shift:Day
Exempt/Non-Exempt:Exempt
Business Unit:ForHealth Consulting
Department:ForHealth Consulting - Community Service - W401950
Job Type:Full-Time
Num. Openings: 1
Post Date: Nov. 13, 2025
Work Location:100% Remote
Salary Minimum:USD $80,000.00/Yr.
Salary Maximum:USD $95,000.00/Yr.
Apply
Refer a Friend
Back
Nurse Reviewer II-Case Mgt (Home Based with Client Visits)
Job Number: 2025-48959
Category:Healthcare
Location: Westborough, MA
Shift:Day
Exempt/Non-Exempt:Exempt
Business Unit:ForHealth Consulting
Department:ForHealth Consulting - Community Service - W401950
Job Type:Full-Time
Num. Openings: 1
Post Date: Nov. 13, 2025
Work Location:100% Remote
Salary Minimum:USD $80,000.00/Yr.
Salary Maximum:USD $95,000.00/Yr.
ForHealth Consulting at UMass Chan Medical School is seeking a detail-oriented
At ForHealth Consulting, part of
| #LI-VG1 |
POSITION SUMMARY:
ForHealth Consulting at UMass Chan Medical School is seeking a detail-orientedNurse Reviewer IIwith experience caring for individuals with complex medical needs to join our Community Case Management Program. In this role, you will manage a caseload of members, ensuring they receive the long-term services and supports (LTSS) they need to thrive in the community. This position combines the flexibility of remote work with meaningful field interactions through home and site visits.
Youll play a key role on a multidisciplinary team - assessing, planning, coordinating, and authorizing care for individuals with complex medical needs, while collaborating closely with providers, state agencies, and other healthcare partners to ensure continuity and quality of care.
ESSENTIAL FUNCTIONS
- Serve as the clinical case manager for an assigned caseload of members.
- Conduct on-site assessments to determine medical necessity and clinical eligibility for Community Case Management and Continuous Skilled Nursing Services.
- Authorize, coordinate, and monitor long-term care services in accordance with program guidelines.
- Prepare and maintain comprehensive service records and documentation in compliance with program and HIPAA requirements.
- Collaborate with providers, hospitals, and agencies to foster integrated care delivery.
- Review service plans and modify as needed based on member progress or changing needs.
- Participate in performance improvement initiatives and support onboarding of new clinical staff.
REQUIRED QUALIFICATIONS:
- RN licensed to practice in Massachusetts
- 5-7 years of work experience with at least 3 recent years providing direct service or case management to the pediatric, young adult, or adult medically complex population
- Ability to travel statewide to Member homes and service providers places of business
- Experience with Office Application and database
- Valid Drivers license required
PREFERRED QUALIFICATIONS:
- Experience with home care
- Knowledge of applicable state regulations
- Experience with prior authorization and/or eligibility determinations
- Experience with the care of medically complex individuals
Why Join Us
At ForHealth Consulting, part ofUMass Chan Medical School, we are dedicated to advancing health and well-being across Massachusetts communities. Youll be part of a mission-driven organization that values collaboration, innovation, and compassion in care management.
#LI-VG1Posting Disclaimer:
This job posting outlines the primary responsibilities and qualifications for the role but is not intended to be an exhaustive list. Duties and expectations may evolve in response to the needs of the department and the broader institution.
In alignment with our commitment to pay transparency, the base salary range for this position is listed above (exclusive of benefits and retirement). At UMass Chan Medical School, final base salary offers are determined based on a combination of factors, including your skills, education, and relevant experience. We also consider internal equity to ensure fair and consistent compensation across our teams.
Please note that the range provided reflects the full base salary range for this position. Offers are typically made within the midrange to allow for future growth and development within the role.
In addition to base pay, UMass Chan offers a comprehensive Total Rewards package, which includes paid time off, medical, dental, and vision coverage, and participation in a 401(a)-retirement plan, with the option to contribute to a voluntary 403(b) plan.
UMass Chan welcomes all qualified applicants and complies with all state and federal anti-discrimination laws.
Freqently Asked Questions
To be eligible for the Nurse Reviewer II-Case Management role in Massachusetts, you must hold a current RN license in the state and have 5-7 years of nursing experience, including several years managing medically complex patients. Additional expertise in home care and state regulations enhances your candidacy.
This position offers full remote work flexibility, but requires travel within Massachusetts for onsite assessments and client visits. Balancing telework with these field interactions ensures comprehensive case management for members with complex medical needs.
Managing caseloads, performing clinical eligibility assessments, authorizing long-term care services, and collaborating with healthcare providers are core duties. The role demands meticulous documentation and ongoing plan adjustment to meet evolving patient needs.
The Nurse Reviewer II position at UMass Medical School offers pathways to leadership within clinical case management and consulting. Employees benefit from professional development and the chance to influence community health outcomes in a respected academic medical environment.
UMass Medical School fosters work-life balance with 100% remote work options and scheduled day shifts. This flexibility, combined with a supportive culture, helps Nurse Reviewer II professionals manage demanding caseloads while maintaining personal well-being.
Westborough's healthcare sector shows steady demand for skilled nurse reviewers, especially those adept in case management for complex patients. Competition is moderate, benefiting candidates with local licensure and experience in community-based care.
Salary for this position ranges from approximately $80,000 to $95,000 annually, reflecting experience and qualifications. This aligns with regional healthcare compensation trends for specialized nursing roles combining remote and field work.
UMass Medical School’s Nurse Reviewer II role uniquely blends remote case management with community-based site visits, emphasizing multidisciplinary collaboration and academic medical resources, which enriches clinical decision-making and patient coordination.
UMass Medical School favors candidates with prior home care experience, familiarity with Massachusetts state healthcare regulations, and skills in prior authorization processes. These qualifications support effective management of the medically complex population served.
Navigating diverse healthcare providers, ensuring timely service authorization, and adapting plans to fluctuating patient needs require strong clinical judgment and communication skills. Traveling across the state adds logistical complexity to maintaining seamless care continuity.
Find The Related Jobs
A-line Staffing Solutions Llc
*Nurse Practitioner
Medway, MA
A-line Staffing Solutions Llc
*Nurse Practitioner
Worcester, MA
A-line Staffing Solutions Llc
*Nurse Practitioner
Spencer, MA
A-line Staffing Solutions Llc
*Nurse Practitioner
Oxford, MA
A-line Staffing Solutions Llc
*Nurse Practitioner
Leominster, MA
A-line Staffing Solutions Llc
*Nurse Practitioner
Holden, MA