Care and Case Managers - Baystate Health

Req#: R18860
Category(s): Nursing, Care and Case Managers
Full Time / Part Time: Per Diem
Shift: First

Summary: 

The Hospital Case Manager is a registered nurse responsible for the coordination of clinical care, quality, and financial outcomes of a designated population of patients. The Hospital Case Manager is responsible for overseeing an efficient plan that will ensure continuity and effective community or post acute reentry. The Hospital Case Manager leads the interdisciplinary team in developing complex discharge plans.

Job Responsiblities: 

1) Facilitates patients care plan as called for in the plan of care

2) Leads daily patient care huddles with nursing to direct timely progress along the continuum

3) Works cooperatively as a leading member of the health care team to insure appropriate use of hospital resources, patient satisfaction, and achievement of quality of care. Manages input from all health care professionals and conducts assessments to determine patients health care and transitional needs. Supports and provides input on case management design.

4) Evaluates and ensures appropriateness of admissions and continued stay using evidence based criteria

5) Collaborates and manages outcomes with the payers through ongoing written and verbal communications to appropriate parties

6) Leads discussions with Physician advisors and MD’s about safe plan for transitions

7) Leads the team to ensure appropriate utilization of patient resources and directs care to other settings when appropriate

8) Collaborates with community case managers and other health care advisors to ensure a smooth and safe continuum of care plan

9) Conducts extensive assessments and implements interventions for patients at risk for readmissions

10) Manages concurrent denials and works with physicians to overturn for appropriate reimbursement

Required Work Experience: 

1) Hospital Case Management experience – 5 years

Preferred Work Experience: 

1) Hospital Case Management Experience

Skills and Compentencies: 

1) Requires a working knowledge of community resources and Utilization/Quality Review standards and activities conducted by third party payers

2)  Ability to organize and prioritize workload in order to meet deadlines

3)  Must possess excellent interpersonal skills in order to interact with all levels of health care providers, support staff, and third party payers where appropriate

4)  Excellent computer skills

     

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.

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