Care and Case Managers - Baystate Health
Category(s): Nursing, Care and Case Managers
Full Time / Part Time: Part-Time
The Hospital Case Manager is a registered professional nurse who facilitates and enhances collaboration with patients, families, physicians, and healthcare providers to ensure patients receive the services required to improve healthcare outcomes and quality of life. The Hospital Case Manager seeks to ensure that quality care is provided to patients and actively participates in the process to improve operational efficiency and patient outcomes.
The Hospital Case Manager participates in the implementation of a patient-centered plan of care. Coordinates input from all health care professionals, conducts assessments of patient and family needs, facilitates and documents the discharge plan, and ensures continuity of care. The Hospital Case Manager utilizes appropriate case management tools to coordinate the appropriate resources for safe and quality hospital transition in alignment with medical management initiatives and product line goals. Evaluates the appropriateness of admissions and continued stay using approved criteria. Collaborates with payers through ongoing written and verbal communication to optimize the reimbursement potential for all Baystate Health hospitals. Adheres to system and department Compliance policies and any applicable laws and regulations. Provides quality case management coverage seven days a week
1) Uses Case Management skills to ensure quality patient-centered care is achieved. Utilizes effective communication with peers, patients, and families. Performs daily review of cases and makes appropriate recommendations to the care team for practice guideline utilization, LoS, and quality of care. Recognizes the case manager's role in assessing, facilitating, collaborating, and coordinating patient services through the continuum of care.
Effectively collaborates with others on the healthcare team to resolve patient care issues. Applies utilization criteria correctly and responsibly best to portray the care delivery process for all BH hospitals. Identifies appropriateness of admission and concurrent days of stay. Provides verbal and written notices of non-coverage to patients and/or their representatives in accordance with departmental policies and third-party regulations
2) As applicable, communicate effectively and efficiently with insurance companies to avoid the denial/appeal process whenever possible. Understands the role of the Physician Advisor for Case Management and makes appropriate referrals for review. Provides a clear and concise review. Ensures CM leadership is informed on issues of prolonged LOS, patient/family concerns, and insurance payment issues
3)Provides post-acute hospital care planning/discharge facilitation.
Proactively works with the healthcare team to identify those patients who will need some level of care following their acute hospitalization. Involves patients/families in the discharge planning process to facilitate a clear understanding by all parties. Monitors each patient’s discharge plan of care for variance and, makes appropriate recommendations and revises the plan as necessary. Assures that interventions are in alignment with medical management initiatives. Provides appropriate financial/regulatory information to patients and/or families including the scope of reimbursement sources. Follows all state and federal guidelines in regard to patient rights in planning for their post-acute needs
4) Demonstrates strong clinical knowledge as part of the healthcare team to ensure quality, evidenced based care is delivered. Demonstrates strong clinical knowledge in the patient population being managed. Continually seeks to develop their body of clinical knowledge. Serves as a resource to members of the healthcare team
5) Collaborates with community case managers and other health care advisors to ensure a smooth and safe continuum of care plan. Provides timely documentation of the post-acute care plan in the medical record.
6) Collaborates with community case managers and other health care advisors to ensure a smooth and safe continuum of care plan. Provides timely documentation of the post-acute care plan in the medical record.
7) Active participant in daily unit progression rounds with interdisciplinary teams to direct timely care progression along the continuum, focusing on appropriate GMLOS.
8) Assumes Responsibility for Own Professional Growth. Attends educational programs to maintain current knowledge in utilization management, discharge planning, and case management with specific emphasis on own areas of responsibility. Attends educational programs to maintain knowledge of current clinical management of patient problems on assigned clinical areas. Establishes annual goals for professional growth and seeks opportunities that lead to the accomplishment of these goals. Attends regularly scheduled departmental meetings as guided by the department manager and/or supervisor.
Minimally Required Education:
Bachelors Degree with approval from CNO, candidates with an Associate’s Degree may be considered
Minimally Required Experience:
Minimum 3-5 years of recent acute medical-surgical nursing experience
1-3 years Case Management
You Belong At Baystate
At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.
DIVERSE TEAMS. DIVERSE PATIENTS. DIVERSE LOCATIONS.
Bachelor of Nursing Degree, Diploma in Nursing (Required)
Case Management Certification – Other, RN Nurse Practitioner – Other
Equal Employment Opportunity Employer
Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.