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Case Management Resource Specialist

2 months ago

Boston, United States Massachusetts General Hospital(MGH) Full time

Reporting to the CMRS Manager, the Case Management Resource Specialist (CMRS) works collaboratively with the Discharge Planning RN Case Managers; providing direct administrative support to the discharge planning processes and to the department. The person in this position will spend time on the clinical units and have direct interaction with patients and their families, clinical and ancillary hospital staff, and other internal and external customers. The CMRS must have strong communication skills and the ability to converse comfortably with patients and their caregivers, department staff, and unit-based staff. The position requires a high degree of flexibility, independence and willingness to participate in multiple activities and provide support to all members of the Case Management Department.

Work collaboratively with Case Managers to support patients discharge plan and care needs along the continuum. This may include, but is not limited to:

• Support and coordination of referrals to internal and external resources, such a

rehabilitation facilities, VNAs, hospice, DME providers, high tech vendor

• Actively manages 4NEXT referrals along the continuum of care, including communication with facilities, agencies, and vendors to promote patient progression to discharge and effective transitions of care.

• Researches and secures out of state and in-network VNAs and facilitie

  • Researches/queries insurers for in-network providers for post-acute needs, such as rehab facilities, DME providers, other contracted vendors.
  • Communicates with insurance companies to expedite and/or manage delays with authorization for post-acute care and services.
• Secures DME and oxygen for post-acute needs; maps insurance and geography to identify

appropriate vendors: assesses insurance benefits and coordinates the necessary paperwork with

the external vendors and medical team for approval for equipment, such as letters of medical

necessity, medical record documentation, and prescriptions. Arranges for and tracks delivery of

equipment prior to or post-discharge.

• Works collaboratively with the Case Manager, Brewster Ambulance Services Transportation Coordinator and the VPNE care van ambassador to coordinate the various modes of discharge transportation.

• Supports the Capacity Coordination Center Case Manager to facilitate network-affiliate hospital to hospital repatriations and with the unit-based CM for non-affiliate repatriations.
  • Assesses, via electronic systems, patient's insurance plans and benefits, such as MassHealth eligibility and Medicare benefits and facilitates coordination with Patient Financial Services
  • Prepares, explains to patients, and documents delivery of the Medicare Important Message and Medicare Outpatient Observation Notice.
  • Initiates and/or completes regulatory and other forms, such as MassHealth Long-Term Care and DMH/DDS PASSR forms and processes the completed forms with the appropriate agencies.
• Identify and refer to community services, as indicated

• Accesses and navigates the EMR to obtain essential information and documents CMRS progress notes and Resource Specialist Quick Notes per department standards.

Research community resources and programs available for patients and their caregivers including,

but not limited to:
  • Assisted Living Facilities
  • Legal and financial resources
  • Private duty and block-nursing agencies
  • Out of state providers
Qualifications
  • High school diploma, GED, some college or associate degree required.
  • Bachelor's degree preferred.
  • Minimum of 2 years work experience, preferably in healthcare
  • Knowledge and understanding of medical terminology.
  • Excellent computer skills, including proficiency with electronic medical records.
  • Strong organizational and prioritizing skills
  • Flexibility and accountability
  • Strong communication, interpersonal and customer service skills
  • Excellent assessment and problem-solving skills


EEO Statement

Massachusetts General Hospital is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. Applications from protected veterans and individuals with disabilities are strongly encouraged.