Registered Nurse (RN) Inpatient Care Coordinator

Baystate Health•Springfield, MA

About The Position

The Hospital Sr Case Manager is a registered professional nurse who facilitates collaboration among patients, families, physicians, and healthcare providers to ensure patients receive services that improve healthcare outcomes and quality of life. The role supports quality care, operational efficiency, and patient outcomes while participating in patient-centered care planning. The case manager coordinates input from healthcare professionals, assesses patient and family needs, facilitates and documents discharge plans, and assures continuity of care. The role uses case management tools and resources to support safe, quality hospital transitions aligned with medical management initiatives and product line goals. It evaluates the appropriateness of admissions and continued stays using approved criteria, and collaborates with payers to optimize reimbursement for Baystate Health hospitals. The position adheres to system and department compliance policies and applicable laws and regulations, and provides case management coverage seven days a week. The RN Sr Case Manager also supports team development and operations by educating and orienting new case managers, serving as a clinical and troubleshooting resource, providing weekend and holiday leadership support as needed, and acting as a superuser and trainer for new programs and services. The role mentors less experienced case managers and independently coordinates care for medically and socially complex patients.

Requirements

Registered professional nurse.
At least 3 years of case manager experience.
At least 1 year as a Case Manager at Baystate Health.
Bachelor's degree required; applicable experience and an Associate's Degree in Nursing may substitute for the bachelor's degree.
Strong clinical knowledge of the patient population being managed.
Ability to critically think, problem solve, and coordinate care for medically and socially complex patients with autonomy.

Nice To Haves

Leadership experience.
Transitional care experience.

Responsibilities

Use case management skills and effective communication to support quality, patient-centered care.
Review cases daily and recommend practice guideline utilization, length-of-stay, and quality-of-care actions to the care team.
Assess, facilitate, collaborate, and coordinate patient services across the continuum of care; work with the healthcare team to resolve care issues.
Apply utilization criteria and identify the appropriateness of admissions and concurrent days of stay.
Provide verbal and written notices of non-coverage to patients or representatives in accordance with departmental policies and third-party regulations.
Communicate with insurance companies to help avoid denials and appeals; make appropriate referrals to the Physician Advisor for Case Management and provide clear, concise reviews.
Keep case management leadership informed about prolonged length of stay, patient and family concerns, and insurance payment issues.
Plan and facilitate post-acute care and discharge; proactively identify patients needing care after hospitalization and involve patients and families in planning.
Monitor discharge plans for variances, recommend changes, and revise plans as needed in alignment with medical management initiatives.
Provide patients and families with appropriate financial and regulatory information, including information about reimbursement sources, and follow state and federal patient-rights guidelines for post-acute planning.
Use clinical knowledge to support evidence-based care, maintain knowledge of the assigned patient population, develop clinical expertise, and serve as a resource to the healthcare team.
Collaborate with community case managers and healthcare advisors to support a safe, smooth continuum-of-care plan.
Document post-acute care plans promptly in the medical record.
Conduct extensive assessments and implement interventions for patients at risk of readmission.
Participate in daily interdisciplinary unit progression rounds to support timely care progression and appropriate GMLOS.
Maintain professional growth by attending education programs in utilization management, discharge planning, case management, and clinical management; establish annual growth goals and pursue opportunities to meet them.
Attend scheduled departmental meetings and present topics or ideas when requested by the manager.
Provide education and orientation to new case managers and assist other areas when experience and clinical knowledge are needed.
Serve as a first-level troubleshooting resource for the team and as a weekend or holiday leadership resource as needed.
Act as a superuser for new programs and services and provide train-the-trainer support in appropriate settings.
Mentor less experienced case managers, lead by example, demonstrate Baystate's Core Competencies, and use critical thinking and problem solving to coordinate care for medically and socially complex patients with autonomy.
Adhere to system and department compliance policies and applicable laws and regulations.
Provide quality case management coverage seven days a week.