Care and Case Managers - Baystate Health

Req#: R18294
Category(s): Nursing, Care and Case Managers
Full Time / Part Time: Per Diem
Shift: First

The Hospital Case Manager/ Utilization 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 Responsibilities: 
    •  Evaluates and ensures appropriateness of admissions and continued stay using evidence based criteria
    • Collaborates and manages outcomes with the payers through ongoing written and verbal communications to appropriate parties
    • Leads the team to ensure appropriate utilization of patient resources and directs care to other settings when appropriate
    •  Manages concurrent denials and works with physicians to overturn for appropriate reimbursement

Required Work Experience: 

  • MA Licensed RN BSN Required
  • 3-5 years clinical Nursing experience
  • Hospital Case Management, Care Coordination experience strongly preferred
  • Certification in Case Management preferred

Skills and Competencies: 

  • Requires a working knowledge of community resources and Utilization/Quality Review standards and activities conducted by third party payers
  • Ability to organize and prioritize workload in order to meet deadlines
  • Must possess excellent interpersonal skills in order to interact with all levels of health care providers, support staff, and third party payers where appropriate
  • Excellent computer skills
  • Must possess excellent interpersonal skills in order to interact with all levels of health care providers, support staff, and third party payers where appropriate

Other Information

  • Per Diem – Must be available to work weekend rotation

     

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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