RN Case Manager for Dual Eligible Special Need Plan

Rn Case Manager

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

The Opportunity

The RN Case Manager serves as a core member of the care team by coordinating and supporting healthcare within the facility and coordinating referrals for services outside the clinic. The RN provides outreach and enrollment services to meet eligibility requirements of the program and surrounding counties, and ensures coordination and planning, including community and family support, by focusing on the development and coordination of community service plans and partnering with service providers, families, and patients to create a plan of healthcare.

Essential Functions

- Conduct client assessments and planning. - Modify patient treatment plans as indicated by patients' responses and conditions. - Prepare patient/family for discharge. - Communicate with third party payers to obtain necessary authorization for reimbursement of services. - Define care goals of patients by providing education, information, and direction to each individual and family. - Review cases with medical directors on challenging cases as needed. - Maintain accurate, detailed reports and records.

Qualifications

What You'll Bring:

- Associate's Degree Nursing required (Bachelor's Degree Nursing preferred).

- Active and unrestricted Registered Nurse (RN) Licensure for the state of Massachusetts required.

- 2+ years of case management and/or discharge planning required.

- Experience working with complex dually eligible populations required. - Knowledge of Managed Care preferred.

- Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care preferred.

- Utilization Review experience preferred.

Additional Skills and Abilities:

- Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times. - Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems. - Ability to establish strong rapport and relationships with patients and staff. - Proficient in Microsoft Office and industry related software programs. - Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions. - Ability to maintain client and staff confidentiality.

Schedule and Working Model

- Full-time (40 hours) Monday through Friday, ~8:30am-5pm.

- Hybrid: Approximately 2 days per week in the field and 3 days per week at home, with flexibility as needed.

Remote Type

Hybrid

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$58,656.00 - $142,448.80/Annual

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

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