Acute Care Case Manager
7 days ago
- Specialty: Acute Care Case Management
- Discipline: RN
- Duration: Ongoing
- 40 hours per week
- Shift: 8 hours, days
- Employment Type: Staff
At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. When determining base pay, we take a comprehensive approach that considers your skills, relevant experience, education, certifications, and other critical factors. The pay information provided offers an estimate based on the minimum job qualifications, but it does not encompass all the elements that contribute to your total compensation package.
Summary of PositionThe RN Case Manager (CM) facilitates a discharge plan including the coordination of post-acute care/services for patients admitted to Home Hospital. The CM may also oversee the coordination of care for both inpatient and outpatient of those patients identified as high risk for readmission. The CM will develop and implement discharge plans for those patients identified as needing post-acute discharge services or post-acute follow up in collaboration with the patient/legal representative, health care team/provider, insurer, and others, including community-based organizations, as needed. The CM uses a collaborative process of assessment, planning, facilitation, and advocacy. S/he may use a high-risk screening criteria or other acceptable screening tools to determine what patients may benefit from specialized care coordination services. The CM consults and collaborates with physicians regarding medical necessity of admissions and appropriate level of care for hospitalized patients utilizing nationally accepted criteria. He/she routinely reviews patients' health records and communicates with the health care 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. The CM completes timely and accurate insurance reviews as requested by third party payers. The CM will 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. He/she participates in quality and risk management case finding activities. The role requires the ability to offer creative, problem-solving solutions using sound and prudent clinical judgment and within the scope of licensure and according to case management standards of practice. The CM seeks out educational and self-development opportunities related to care coordination, transitions of care, healthcare reimbursement, and other pertinent areas.
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