Nurse Case Manager

4 days ago


Arlington, Virginia, United States Mass General Brigham Full time
Job Description & Requirements
  • 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.

Job Summary

The 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.

Responsibilities
  • Case Management Process
    • Identify patients who would benefit from case management services.
    • Assess and prioritize patient needs, determining the type of services and resources required.
    • Develop and implement a care coordination plan in collaboration with the patient, family, caregivers, and healthcare team.
    • Evaluate and revise the plan as needed.
  • Discharge Planning
    • Identify patients requiring post-discharge services using high-risk screening criteria or referrals.
    • Assess patient discharge planning needs based on medical condition, previous history, functional status, psychosocial support, living situation, and previous post-discharge or homecare services.
    • Include patient and/or family and caregivers in the discharge planning process through verbal and written communication.
    • Facilitate safe, effective, and efficient discharge plans in collaboration with the patient, family, caregivers, attending physician, nursing staff, and other healthcare professionals.
  • Utilization Management
    • Provide expert guidance to medical, nursing, and rehab staff on hospital criteria, insurance regulations, care coordination efforts, and discharge planning activities.
    • Perform admission and concurrent utilization management using hospital-approved criteria as a guide for determining the appropriate level of care.
    • Complete accurate insurance utilization reviews and obtain third-party payer approval of services needed for post-hospital care as needed.
  • Quality/Performance Improvement
    • Participate in performance improvement measurements and initiatives, including identification of variances/delays.
    • Participate in inter-departmental committees, focus groups, task forces, or other special projects as requested.

The RN Case Manager 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.

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 RN Case Manager seeks out educational and self-development opportunities related to care coordination, transitions of care, healthcare reimbursement, and other pertinent areas.


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