Nurse Case Manager- 24 hrs, Days

Beth Israel Lahey Health•Milton, GA

5d•$77,126 - $193,107

About The Position

The RN Case Manager works within the Triad Model of Care Transitions and partners with the interdisciplinary care team to facilitate progression of care for hospitalized patients. In collaboration with medical providers and other care team members, the role supports efficient, high-quality care, appropriate use of clinical resources, and safe, timely patient discharge. The RN Case Manager navigates health system services to support effective transitions, advises the team on healthcare industry compliance, and promotes throughput, clinical effectiveness, and fiscal responsibility. This is a 24-hour-per-week day position requiring weekday availability. The position requires light physical effort in a normal work environment. Beth Israel Lahey Health requires staff to be vaccinated against influenza as a condition of employment.

Requirements

RN licensure in the state of Massachusetts.
3–5 years of experience in an acute care setting.
Effective verbal and written communication, relationship-building, and negotiation skills.
Weekday availability.

Nice To Haves

Bachelor’s degree in nursing or another healthcare-related field.
ACM, CCM, or CMAC certification.

Responsibilities

Review cases within 24–48 hours or the next business day after admission or bed placement, and each day throughout the stay, to support care progression, estimate length of stay, and plan transitions.
Collaborate with the medical team to develop treatment plans that support care transitions and patient flow.
Assess admissions and observation patients to identify needs, available resources, barriers to length of stay and discharge, and anticipated transition resources.
Coordinate with physicians and clinical departments to ensure tests, treatments, consultations, and procedures are appropriately indicated and completed in a timely manner.
Communicate the care plan, expected discharge date, and transition needs to patients, caregivers, and care team members, and intervene when care progression deviates from the plan.
Create and coordinate transition plans with social workers, direct care providers, hospital departments, external organizations and facilities, community services, and patients and families or caregivers.
Participate in daily multidisciplinary rounds, apply evidence- and best-practice milestones, and communicate plans to the care team.
Inform the interdisciplinary team about estimated length of stay, barriers to care progression, anticipated disposition, and actions needed to support the plan.
Arrange appropriate clinical follow-up and initiate referrals to post-acute providers.
Ensure patients and caregivers understand the plan and have resources to support success after discharge.
Use appropriate clinical guidelines to guide the care plan, anticipated length of stay, and patient status.
Contact payers when required to verify coverage and benefits for anticipated discharge needs.
Identify patients at risk of readmission and initiate interventions, engaging appropriate community resources.
Document avoidable days, case management assessments, and care plans thoroughly and promptly according to department policy.
Ensure provider documentation supports the anticipated discharge plan and escalate deviations to the Physician Advisor when appropriate.
Communicate issues affecting patient flow, satisfaction, safety, length-of-stay management, or outcomes to the department director or appropriate stakeholders.
Serve as a resource on governmental and healthcare industry regulations, support compliance, and communicate applicable standards to the interdisciplinary team.
Maintain current knowledge of organizational policies, care transitions, clinical trends, and regulatory requirements related to clinical care, discharge planning, and post-acute authorization.
Attend and contribute to departmental meetings and participate in multidisciplinary committees, workgroups, and other committees as directed.
Manage quality indicators, including avoidable delays, length of stay, resource utilization, patient satisfaction, patient flow, outlier management, and readmissions, and suggest strategies to improve performance.