Hospital Case Manager RN

2 weeks ago

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

Job Summary:

The Hospital Case Manager is a registered nurse responsible for coordinating clinical care, quality, and financial outcomes of a designated population of patients.

This role involves overseeing an efficient plan to ensure continuity and effective community or post-acute reentry.

The Hospital Case Manager leads the interdisciplinary team in developing complex discharge plans.

Key Responsibilities:
  • Facilitate patient care plans as called for in the plan of care.
  • Lead daily patient care huddles with nursing to direct timely progress along the continuum.
  • Work cooperatively as a leading member of 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 and manage outcomes with payers through ongoing written and verbal communications to appropriate parties.
  • Lead discussions with physician advisors and MDs about safe plans for transitions.
  • Lead the team to ensure appropriate utilization of patient resources and direct care to other settings when appropriate.
  • Collaborate with community case managers and other healthcare advisors to ensure a smooth and safe continuum of care plan.
  • 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:
  • MA RN License, BSN preferred.
  • 3-5 years clinical nursing experience.
  • Hospital case management, care coordination experience strongly preferred.
  • Certification in case management preferred.
Work Schedule:
  • Part-time 16 hours - Monday to Friday.
  • Weekend & Holidays - Every 10th weekend & 1 holiday a year.
Skills and Competencies:
  • Requires a working knowledge of community resources and utilization/quality review standards and activities conducted by third-party payers.
  • Ability to organize and prioritize workload in order to meet deadlines.
  • Must possess excellent interpersonal skills in order to interact with all levels of healthcare providers, support staff, and third-party payers where appropriate.
  • Excellent computer skills.

About Baystate Health:

At Baystate Health, we know that treating one another with dignity and equity is what elevates respect for our patients and staff.

It makes us not just an organization, but also a community where you belong.

We advance the care and enhance the lives of all people.

Equal Employment Opportunity Employer:

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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