RN Float Care Manager Care Management 20 Hours Every 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 individuals health needs using communication and available resources to promote quality costeffective 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 costeffective 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.

Position: RN Float Care Manager

Department: Care Management

Schedule: 20 Hours (Every Weekend)

ESSENTIAL RESPONSIBILITIES / DUTIES:

Duties and Responsibilities: (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 individuals level of physical/mental impairment; understand the physical and psychological characteristics of illness; ability to assist individuals with the development of short and longterm 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 clients 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 preacute and postacute venues of care and postacute 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 as a Registered Nurse in the commonwealth of Massachusetts

CCM or related certification attained within 24 months from the hire date is preferred

EXPERIENCE:

35 years of diversified clinical experience is required

A minimum of 2 years of previous experience involving judgment and decision making preferably in a utilization management/case management position

KNOWLEDGE AND SKILLS:

• Extensive background and knowledge of current medical/surgical patterns of practice.

• Medical terminology and standard medical abbreviations.

• Managed care concepts the various health care delivery systems

• Methods for assessing an individual are level of physical/mental impairment understanding of the physical and psychological characteristics of illness and understanding of expected treatment.

• Confidentiality issues and the legal and ethical issues pertaining to them.

• ICD9 and CPT nomenclature and the ability to interpret and convert this information as applicable.

• Knowledge of benefits and various plan contracts eligibility issues and requirements.

• Role and functional responsibilities of case management professional; case management program philosophy and purpose within Managed Care Program

• Excellent interpersonal verbal and written communication and negotiations skills

• Strong analytical data management and PC skills

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

Equal Opportunity Employer/Disabled/Veterans