RN Care Coordinator (Case Manager) BWH

Mass General Brigham•Boston, MA

13d•$42 - $106•Onsite

About The Position

The RN Care Coordinator (RNCC) manages a caseload of patients and is responsible for care that supports desired clinical and financial outcomes. The role applies knowledge specific to assigned patients’ needs and coordinates care prescribed by an interdisciplinary team. Using patient assessments, care guidelines, protocols, payer regulations, and responses to therapy, the RNCC assesses the episode of illness from pre-admission through post-discharge. The position also contributes to evaluation of practice patterns and systems, quality, cost, and satisfaction improvement efforts, and efficient use of care-delivery resources. The RNCC coordinates implementation of care plans, discharge planning, and utilization management. This includes collaborating with patients, families, physicians, nurses, other departments, outside providers, and payers to coordinate treatment, arrange post-hospital services, assess care needs, and support appropriate care settings and reimbursement. The role works in a busy and sometimes stressful hospital and office environment and requires flexibility and the ability to work independently.

Requirements

Graduate of an approved school of nursing.
Current Massachusetts nursing registration.
For newly licensed nurses, a Bachelor of Science degree in Nursing is required.
At least 5 years of acute care experience.
At least 1 year of inpatient acute case-management experience.
Strong clinical assessment skills.
Excellent interpersonal skills and ability to work collaboratively and cooperatively with a team and internal and external customers.
Strong organizational skills and ability to set priorities.
Ability to compile data from concurrent and retrospective medical-record review to determine clinical appropriateness.
Ability to address patient needs based on clinical diagnosis, level of care, and discharge plan.
Ability to negotiate several aspects of care coordination simultaneously.
Excellent written and verbal communication skills.
Flexibility and ability to work well independently.

Nice To Haves

Bilingual English/Spanish skills.
Previous experience in a hospital or health care setting.

Responsibilities

Develop a provisional treatment program and tentative discharge date, typically before admission or within 24–48 hours of admission, using input from the patient or family and the care team.
Review daily treatment plans with physicians, nurses, patients, and families to support interdisciplinary communication and coordination.
Participate in patient care rounds, contribute to care planning, and monitor and report patient progress.
Coordinate the sequencing and scheduling of interventions, consultations, treatments, and ancillary services with other departments.
Maintain continuity with patients and ensure their discharge-related needs are addressed.
Apply utilization-management principles and payer contracts to care plans and inform physicians and nurses of their implications.
Present alternatives to inpatient care based on assessed level of care and insurance benefits.
Consult Care Coordination leadership regarding outlier and potentially or actually resource-intensive patients.
Coordinate with internal and external health care providers to facilitate care, including post-discharge services.
Contribute to the development, implementation, and monitoring of practice guidelines.
Identify case-management learning needs among attending physicians, residents, and nurses, and work with service leaders on education plans.
Assess continuing-care needs with other caregivers and coordinate patient and family meetings about discharge as appropriate.
Coordinate the discharge planning process, including patient education, identification of post-hospital service, treatment, and funding options, and timely finalization of plans.
Follow up with patients and families after discharge to monitor and support desired outcomes.
Contact home health agencies and extended care facilities to support timely transitions of care.
Identify patients likely to have unmet insurance or resource needs and communicate or refer them to appropriate team members and departments.
Communicate with third-party payers about patient progress and serve as their primary source of patient information.
Issue Medicare notices of non-coverage when needed and document related communications and processes.
Use accepted utilization or medical-management criteria, including InterQual, to identify, monitor, and report variances involving admission appropriateness, continued stay, treatment delays, and discharge planning.
Conduct and document utilization reviews for insurers or intermediaries and identify SNF and AND days for Medicare and Medicaid patients.
Take concurrent action to reduce or eliminate inappropriate admissions and hospital days, system delays, and level-of-care concerns affecting claims and reimbursement.
Review utilization reports with colleagues and provide feedback on utilization trends and payer issues.