The RN Case Manager is autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost-efficient patient outcomes.
Key Job Responsibilities: see job posting for a comprehensive description
· Looks for opportunities to reduce cost while assuring the highest quality of care is maintained.
· Applies review criteria to determine medical necessity for admission and continued stay.
· Provides clinically based case management, discharge planning and care coordination to facilitate the delivery of cost-effective quality healthcare and assists in the identification of appropriate utilization of resources across the continuum of care.
· Works collaboratively with interdisciplinary staff internal and external to the Organization.
· Participates in quality improvement and evaluation processes related to the management of patient care.
· Responsible for reviewing the medical record of all observation and inpatient admissions and continued stays to ensure appropriate utilization and delivery of care.
· Interacts, communicates, and intervenes with multi-disciplinary healthcare team in a purposeful, goal-directed fashion. Works pro-actively and utilizes critical thinking skills to maximize the effectiveness of resource utilization. Anticipates, initiates, and facilitates problem resolution around issues of resource use and continued hospitalization, discharge planning.
· Maintains an updated knowledge base of and references resources outlining provider benefits for care choices, including public, private, and governmental payers and established / preferred ACO relations.
· Responsible for department operational excellence, regarding safe and effective discharge planning; assures department delivers quality services in accordance with applicable policies, procedures and professional standards.
Minimum Education:
· Registered Nurse
· BSN strongly preferred
Required Licenses / Registrations
RN Registered Nurse
Minimum Work Experience:
· 3-5 years acute care hospital experience preferred
· Critical Care or Emergency Department experience highly desirable
Knowledge, Skills and Abilities:
· Demonstrated skills in the areas of: negotiation, communication (verbal and written), conflict, interdisciplinary collaboration, management, creative problem solving, and critical thinking, time management and ability to multitask in high stress environment.
· Healthcare financing, community and organizational resources, patient care processes, and data analysis.
· Utilization management as it relates to third party payers
· Post-acute care community resources
· Managed Care
· Excellent verbal and written communication skills required.
· Demonstrates flexibility via an ability to adapt to changing priorities and regulations.
· eDischarge, EHR, Interqual, MCCM, Epic, Workday
Work Schedule
Monday - Friday with a weekend and holiday requirement
Job Type: Full-time
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
Work setting:
Ability to Relocate:
- South Weymouth, MA 02190: Relocate before starting work (Required)
Work Location: In person