RN Case Manager, Home Hospital
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Job Location:
Newton, MA - USA
Monthly Salary:
$ 72217 - 144747
Posted on:
6 hours ago
Vacancies:
1 Vacancy
Job Summary
Site: Mass General Brigham Home Care Inc.
We are seeking an experienced RN Case Manager to coordinate care manage utilization and support safe transitions across the continuum for patients admitted to Home Hospital. The RN Case Manager partners closely with the healthcare team payers patients families and community-based organizations to coordinate care and develop and implement individualized discharge plans.
This role is ideal for an experienced RN who enjoys critical thinking autonomy and working at the forefront of healthcare transformation.
Patient Population
Home Hospital cares for adult patients with a range of acute conditions including heart failure COPD exacerbations pneumonia cellulitis and specialty populations such as those experiencing postpartum hypertension or cirrhosis.
Schedule & Work Environment
This is a full-time (40 hours/week) role designed to support worklife balance with a four-day 10-hour schedule (7:30 AM 6:00 PM subject to change) and participation in a weekend rotation.
The position is primarily remote allowing you to work from home while staying closely connected to a highly collaborative interdisciplinary care team. This position offers a flexible supportive work environment within an innovative care model. Occasional on-site time may be required for training or team meetings at Home Hospital office locations.
This position is represented by the Massachusetts Nurses Association collective bargaining unit.
Identify patients who would benefit from case management services by utilizing high-risk screening criteria.
Perform comprehensive assessments that address the patients medical condition functional status psychosocial needs and discharge planning requirements thereby enhancing patient care throughout the continuum.
Employ a collaborative process of assessment planning implementation care coordination monitoring advocacy and evaluation to meet the individuals health care needs
Meets patients needs efficiently and effectively by enhancing the patient experience upholding institutional standards for high-quality care optimizing resource utilization and supporting appropriate reimbursement.
Coordinate post-acute services community resources and follow-up care to facilitate safe and effective patient transitions.
Collaborate with the interdisciplinary care team to assess medical necessity and determine appropriate levels of care.
Conduct admission and concurrent utilization reviews using approved clinical criteria.
Complete timely and accurate insurance reviews and secure required third-party payer authorizations as required.
Identify and address any service delays or inappropriate utilization of healthcare resources.
Support initiatives to reduce readmissions by enhancing care coordination communication and follow-up processes.
Educate patients and families about care plans insurance coverage and available post-acute care options.
Ensure compliance with federal and state regulations related to discharge planning including adherence to CMS regulations and organizational policies.
Document assessments care plans and ongoing case management activities in accordance with organizational policy and regulatory requirements.
Participate in quality improvement projects audits and special assignments as needed.Hybrid75-95 Wells Ave40RegularDay (United States of America)1410 Mass General Brigham Home Care Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .
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.
We are seeking an experienced RN Case Manager to coordinate care manage utilization and support safe transitions across the continuum for patients admitted to Home Hospital. The RN Case Manager partners closely with the healthcare team payers patients families and community-based organizations to coordinate care and develop and implement individualized discharge plans.
This role is ideal for an experienced RN who enjoys critical thinking autonomy and working at the forefront of healthcare transformation.
Patient Population
Home Hospital cares for adult patients with a range of acute conditions including heart failure COPD exacerbations pneumonia cellulitis and specialty populations such as those experiencing postpartum hypertension or cirrhosis.
Schedule & Work Environment
This is a full-time (40 hours/week) role designed to support worklife balance with a four-day 10-hour schedule (7:30 AM 6:00 PM subject to change) and participation in a weekend rotation.
The position is primarily remote allowing you to work from home while staying closely connected to a highly collaborative interdisciplinary care team. This position offers a flexible supportive work environment within an innovative care model. Occasional on-site time may be required for training or team meetings at Home Hospital office locations.
This position is represented by the Massachusetts Nurses Association collective bargaining unit.
Job Summary
Essential Functions:Identify patients who would benefit from case management services by utilizing high-risk screening criteria.
Perform comprehensive assessments that address the patients medical condition functional status psychosocial needs and discharge planning requirements thereby enhancing patient care throughout the continuum.
Employ a collaborative process of assessment planning implementation care coordination monitoring advocacy and evaluation to meet the individuals health care needs
Meets patients needs efficiently and effectively by enhancing the patient experience upholding institutional standards for high-quality care optimizing resource utilization and supporting appropriate reimbursement.
Coordinate post-acute services community resources and follow-up care to facilitate safe and effective patient transitions.
Collaborate with the interdisciplinary care team to assess medical necessity and determine appropriate levels of care.
Conduct admission and concurrent utilization reviews using approved clinical criteria.
Complete timely and accurate insurance reviews and secure required third-party payer authorizations as required.
Identify and address any service delays or inappropriate utilization of healthcare resources.
Support initiatives to reduce readmissions by enhancing care coordination communication and follow-up processes.
Educate patients and families about care plans insurance coverage and available post-acute care options.
Ensure compliance with federal and state regulations related to discharge planning including adherence to CMS regulations and organizational policies.
Document assessments care plans and ongoing case management activities in accordance with organizational policy and regulatory requirements.
Participate in quality improvement projects audits and special assignments as needed.
Qualifications
Education & Licensure
- Graduate of an accredited school of nursing (BSN preferred).
- Current Registered Nurse licensure in the Commonwealth of Massachusetts.
- CCM or ACMA certification is preferred.
Experience
- At least three years of clinical nursing experience is strongly preferred.
- A minimum of two years of experience in case management utilization review or discharge planning is strongly preferred.
Additional Job Details (if applicable)
- Demonstrates strong clinical judgment and independent decision-making abilities.
- Effectively collaborates within a multidisciplinary care team.
- Uses logic and reasoning to identify the strengths and weaknesses of alternative solutions conclusions or approaches to problems.
- Establishes strong rapport and relationships with patients caregivers and team members.
- Manages time effectively especially when working remotely from the care team.
- Proficient in Microsoft Office Teams 4Next Interqual and other industry-related software programs.
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$72217.06 - $144747.20/AnnualGrade
HCBRN125EEO Statement:
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.
Required Experience:
Manager
Key Skills
- Crisis Management
- Pain Management
- Developmental Disabilities Experience
- Employee Evaluation
- Direct Support
- Management Experience
- Remodeling
- Case Management
- Home Care
- Nursing
- Supervising Experience
- Social Work
About Company
Patients at Mass General have access to a vast network of physicians, nearly all of whom are Harvard Medical School faculty and many of whom are leaders within their fields.
