RN Care Manager, Complex Care Management, 40 Hours (Days)

POSITION SUMMARY:

The care manager is accountable for a designated patient caseload and plans effectively to meet patient needs, manage the length of stay, and promote efficient utilization of resources.  Specific functions within this role include:

• Assessment - The care manager will collect in-depth information about a person’s situation and functioning to identify individual needs to develop a comprehensive care management plan that will address those needs.

• Planning – The care manager will determine specific objectives, goals, and actions as identified through the assessment process.  The plan should be action-oriented and time-specific.

• Implementation – The care manager will execute specific interventions that will lead to accomplishing the goals established in the care management plan.

• Coordination – The care manager will organize, integrate, and modify the resources necessary to accomplish the goals established in the care management plan.

• Monitoring – The care manager will gather sufficient information from all relevant sources to determine the effectiveness of the care management plan.

• Evaluation – At appropriate and repeated intervals, the care manager will determine the plan’s effectiveness in reaching desired outcomes and goals.  This process might lead to a modification or change in the care management plan in its entirety or any of its parts.

Position: RN Care Manager

Department: Care Management

Schedule:  40 Hours, Days - Mon-Friday 7-330, no weekends, no holidays

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ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Conduct a thorough and objective evaluation of the client’s current status including physical, psychosocial, environmental, financial, and health status expectations. As a client advocate, seek authorization for care management from the recipient of services (designee).

JOB REQUIREMENTS

EDUCATION:

• BSN preferred

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

• Licensure to practice as a registered nurse in the state of Massachusetts required.

• CCM or related certification preferred or attained within 24 months from the date of hire.

EXPERIENCE:

• 3-5 years of clinical nursing experience

KNOWLEDGE AND SKILLS:

• Coordination and Service Delivery – The care manager will understand confidentiality and the legal and ethical issues of it; understand medical terminology, how to obtain an accurate history; establish treatment goals; establish working relationships with referral sources; develop treatment plans.

• Physical and Psychological Factors – The care manager will understand methods for assessing an individual’s level of physical/mental impairment; understand the physical and psychological characteristics of illness; be able to assist individuals with the development of short- and long-term health goals.

• Benefit Systems and Cost-Benefit Analysis – The care manager will understand the requirements for prior approval by the 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.

• Case Management Concepts – The care manager will 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. Community Resources – The care manager will understand how to access and evaluate the available resources to meet a client’s needs; will be 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 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.

NursingCM

Equal Opportunity Employer/Disabled/Veterans

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