Full Time Case Manager

Whittier Health Network•Westborough, MA

4d•$34 - $49•Onsite

About The Position

Whittier Rehabilitation Hospital Westborough is seeking a Full Time Case Manager. This role is essential for patient care, involving direct interaction with patients and families from admission to discharge. The Case Manager will assess needs, provide information on the rehabilitation process and resources, and collaborate with the healthcare team to establish and modify treatment plans. Key responsibilities include coordinating discharge planning, making referrals, and ensuring a continuation of services. The role also involves utilization review, maintaining patient privacy, and documenting all case management activities. Participation in performance improvement initiatives is also expected.

Requirements

Registered Nurse
Minimum of 5 years varied nursing experience, preferably orthopedic, med-surg, geriatric or rehabilitation.
Excellent communication (written and verbal), interpersonal and organization skills.
Ability to assess, analyze, plan, implement and evaluate.
Basic knowledge of insurance, including an understanding of eligibility, benefits and limitations.
Knowledge of growth and development across the life span.

Nice To Haves

Case management experience, preferred.

Responsibilities

Meet with every patient/family within 1 working day of admission to introduce case management and begin an assessment of potential discharge planning needs, taking into account patient’s age and developmental level, cultural and religious practices, language and emotional barriers, healthcare needs, financial situation and family/community support.
Provide the patient and family information, in a form that they can understand, about the rehabilitation process, levels of care, homecare services, community resources and patient rights including Advance Directives.
Attend all interdisciplinary team meetings (RTC, FTC, TTC) to collaborate with the healthcare team, patient and family to establish a treatment plan with realistic goals and a target date to achieve the goals. Identify variables that may influence the accomplishment of the goals. Continually evaluate the effectiveness of the plan and modify as needed.
Collaborate with the healthcare team, patient and family for a timely discharge to the next level of care, when appropriate. Assist the team in identifying agencies or facilities that can meet the patient’s healthcare needs.
Make referrals to the next level of care and coordinate the transfer to maintain a continuation of services. Counsel with the patient/family and the payor to coordinate funding for the services. Obtain approval numbers from payor, if needed.
Organize all referral paperwork needed to make discharge referral, review for completeness and fax (or have faxed) to the agency or facility that will continue to provide service.
Maintain patient privacy and confidentiality at all times. Release only information authorized by the patient/responsible party, and only the specific information required.
Act as utilization review coordinators.
Monitor the patient’s level of care at each Rehab Team Conference (RTC), per UR plan.
Refer any cases requiring medical judgment to a physician advisor.
Maintain timely contact with external case managers and third party payors as required under “continued stay review” programs. Obtain approvals for continuation of the treatment plan. Advocate for services at an appropriate intensity to best meet the patient's needs.
Notify members of the team and business office of any exclusions or level of care changes.
Attend Utilization Review Committee meetings, as assigned.
Keep patient and family informed of Utilization Review decisions and provide discharge planning options to meet patient care needs.
Document all case management activities in the patient’s medical record, including notes related to conversations with patient/family, insurers and others in accordance with laws, regulations and hospital policy.
Participate in hospital-wide or department specific performance improvement initiatives as assigned.