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Nurse Case Manager

2 months ago

Waltham, Massachusetts, United States Mass General Brigham Full time
Job Title: Registered Nurse - Case Management

Mass General Brigham is seeking a skilled Registered Nurse to fill a Case Management position in Waltham, Massachusetts.

Job Summary:

We are looking for a dedicated and compassionate Registered Nurse to join our team as a Case Manager. The successful candidate will be responsible for coordinating post-acute care services for patients admitted to Medical, Surgical, Pediatric, or Obstetrical Services, and as needed, for hospital outpatient areas including but not limited to the Emergency Department and Henderson Surgical Center.

Key Responsibilities:
  • Develop and implement discharge plans for patients identified as needing post-acute discharge services or post-acute follow-up in collaboration with the patient/legal representative, healthcare team/provider, insurer, and others.
  • Use a collaborative process of assessment, planning, facilitation, and advocacy to ensure patients receive the necessary care and support.
  • Consult and collaborate with physicians regarding medical necessity of admissions and appropriate level of care for hospitalized patients utilizing nationally accepted criteria.
  • Review patients' health records and communicate with the healthcare team/provider to ensure continued appropriate level of care, compliance with Federal and State regulations related to discharge planning, compliance with CMS regulations or other third-party payers, and appropriate utilization of hospital and medical resources.
  • Complete timely and accurate insurance reviews as requested by third-party payers.
  • Serve as a resource for physicians, hospital staff, and patients and their families in providing information about insurance coverage, limitations of coverage related to discharge planning, community resources, community referrals, and post-acute care options.
  • Participate in quality and risk management case finding activities.
Requirements:
  • Graduate of an accredited school of nursing.
  • Current licensure as a Registered Nurse in the Commonwealth of Massachusetts, with a minimum of three years' clinical experience.
  • Evidence of continued education and professional development.
  • CCM or ACMA certification preferred.
Benefits:
  • Medical benefits.
  • Dental benefits.
  • Vision benefits.
  • Life insurance.
  • Employee assistance programs.