RN, Hospital Case Manager Full Time

3 weeks ago


Springfield, Massachusetts, United States Baystate Health Full time
Hospital Case Manager RN Job Description

Job Summary:

The Hospital Case Manager RN is a registered nurse responsible for coordinating clinical care, quality, and financial outcomes for a designated population of patients. This role involves overseeing an efficient plan to ensure continuity and effective community or post-acute reentry.

Key Responsibilities:
  • Facilitate patient care plans as outlined in the plan of care
  • Lead daily patient care huddles with nursing to direct timely progress along the continuum
  • Collaborate with the healthcare team to ensure appropriate use of hospital resources, patient satisfaction, and achievement of quality of care
  • Evaluate and ensure appropriateness of admissions and continued stay using evidence-based criteria
  • Collaborate with payers through ongoing written and verbal communications to ensure optimal outcomes
  • Lead discussions with physician advisors and MDs regarding safe transitions
  • Ensure appropriate utilization of patient resources and direct care to other settings when necessary
  • Collaborate with community case managers and other healthcare advisors to ensure a smooth and safe continuum of care
  • Conduct extensive assessments and implement interventions for patients at risk for readmissions
  • Manage concurrent denials and work with physicians to overturn for appropriate reimbursement
Requirements:
  • BSN required
  • 3-5 years clinical nursing experience
  • Hospital case management and care coordination experience strongly preferred
Skills and Competencies:
  • Working knowledge of community resources and utilization/quality review standards and activities conducted by third-party payers
  • Ability to organize and prioritize workload to meet deadlines
  • Excellent interpersonal skills to interact with all levels of healthcare providers, support staff, and third-party payers
  • Excellent computer skills
Schedule:

Full-time, Monday-Friday

Weekends and holidays: every 10th weekend and 1 holiday per year

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.



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