Case Manager with Utilization Review experience Hospital at Home Pogram

Beth Israel Lahey Health • Burlington, MA

412d

About The Position

The Inpatient Registered Nurse (RN) Case Manager for the Hospital at Home program is responsible for coordinating utilization review, discharge planning, and monitoring quality assurance for inpatient admissions at Lahey Clinic. This role combines case management and utilization review responsibilities, ensuring that patients receive appropriate care while leading a multidisciplinary team to facilitate timely processes. The position requires participation in weekend and holiday rotations.

Requirements

• Registered Nurse with a Bachelor's Degree or commensurate experience preferred.
• Current Commonwealth of Massachusetts license as a Registered Nurse and Basic Life Support (BLS) certification required.
• Minimum of three years of medical/surgical nursing care experience.
• Two years of Case Management or Utilization Management experience desirable.
• Effective verbal communication, problem-solving, and conflict resolution skills.
• Basic computer and typing skills.
• Basic knowledge of Quality Improvement techniques.
• Demonstrated ability to organize and work independently.

Nice To Haves

• Proven leadership and project management experience.

Responsibilities

• Performs utilization review and discharge planning for inpatient admissions.
• Applies Interqual, AEP, and other review criteria to determine appropriateness for inpatient and outpatient care.
• Utilizes clinical expertise to determine the appropriate level of care for patients.
• Leads the healthcare team in selecting appropriate, safe hospital or alternative care options.
• Works closely with Community Case Managers regarding medically fragile or high-risk patients.
• Identifies delay days and notifies Team Leader.
• Reports serious occurrences and sentinel events to Risk Management.
• Facilitates post-hospital care and develops plans to meet patient needs.
• Manages observation status patients by collaborating with physicians.
• Participates in weekend, holiday, and beeper rotation as needed.
• Supports service line activities related to utilization and quality management.
• Assists in developing and implementing clinical pathways.
• Adheres to insurance, contractual, and regulatory requirements.
• Coordinates and facilitates patient discharge with nursing, social work, and healthcare team members.
• Facilitates timely patient access to post-acute care services.
• Participates in hospital committees representing patient issues and department functions.
• Incorporates Lahey Clinic Guiding Principles, Mission Statement, and Goals into daily activities.
• Complies with Lahey Clinic Policies and behavioral expectations.
• Maintains courteous and effective interactions with colleagues and patients.
• Demonstrates understanding of job description, performance expectations, and competency assessment.
• Commits to meeting customer needs and adheres to Customer Service standards.
• Participates in quality improvement activities and completes Mandatory Education.
• Performs other duties as needed or directed.

Benefits

• Health insurance
• Paid time off
• Retirement savings plan
• Continuing education opportunities
• Employee wellness programs

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Hospitals
• Education Level: Bachelor's degree
• Number of Employees: 10,001+ employees