Registered Nurse Case Manager, 4E, 40 Hours (4 -10hr / Days / Every 6th Weekend)

POSITION SUMMARY:

Utilizing a collaborative process, the care manager will assess, plan, implement, monitor, and evaluate the options and services required to meet an individual’s health needs, using communication and available resources to promote quality, cost-effective outcomes.  The care manager helps identify appropriate providers and facilities throughout the continuum of services while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the patient and the reimbursement source. This care manager is dedicated to handle the increased volume and to support the overall care management process and the department.

ESSENTIAL RESPONSIBILITIES / DUTIES:

(these are a general summary and not all inclusive)

• Ability to understand confidentiality and the legal and ethical issues pertaining to patient health; understand medical terminology, how to obtain an accurate history; establish treatment goals; establish working relationships with referral sources; develop treatment plans.
• Knowledge and understanding of methods for assessing an individual's level of physical/mental impairment; understand the physical and psychological characteristics of illness; ability to assist individuals with the development of short- and long-term health goals.
• Ability to understand the requirements for prior approval by payer; be able to evaluate the quality of necessary medical services; be able to acquire and analyze the cost of care; understand the various health care delivery systems and payer plan contracts; be able to demonstrate cost savings.
• Ability to understand case management philosophy and principles; apply problem solving techniques to the care management process; document care management services; understand liability issues for care management activities.
• Knowledgeable on how to access and evaluate the available resources to meet a client's needs; able to develop new resources.
• Excellent interpersonal, verbal, and written communication and negotiation skills
• Strong analytical, data management and PC skills.
• Current working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement.
• Understanding of pre-acute and post-acute venues of care and post-acute community resources.
• Strong organizational and time management skills, as evidenced by a capacity to prioritize multiple tasks and role components.
• Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.

JOB REQUIREMENTS

EDUCATION:

• Nursing degree: Diploma, ASN or BSN (preferred), Ability to obtain BSN within 4 years

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

• Licensed to practice professional nursing as a Registered Nurse in the Commonwealth of Massachusetts.

EXPERIENCE:

• A minimum of 3-5 years recent clinical experience required, and 1-3 years of recent acute, Inpatient Care Management experience required.

Preferred Skills and Experience

• Multilingual skills (beyond that of English) in languages appropriate to the patient populations served by the medical center preferred.

An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.