RN Care Coordinator (Case Manager) BWH

Mass General Brigham•Boston, MA

1d•$42 - $106•Onsite

About The Position

The RN Care Coordinator (RNCC) manages a caseload of patients and ensures care supports desired clinical and financial outcomes. The position requires knowledge of the needs of assigned patients and coordination of care prescribed by an interdisciplinary team. Using patient assessments, care guidelines, protocols, payer regulations, and responses to therapies, the RNCC evaluates each episode of illness from pre-admission through post-discharge. The role also contributes to the ongoing evaluation of practice patterns and systems and supports efforts to improve quality, cost, and satisfaction outcomes while mobilizing resources to make care delivery more efficient. The RNCC coordinates implementation of plans of care, discharge planning, and utilization management. This includes working with patients and families, physicians, nurses, other care team members, departments, insurers, and post-acute providers to coordinate treatment, determine appropriate levels of care, arrange transitions, and support reimbursement and desired outcomes. The position is based at The Brigham and Women's Hospital, Inc., at 45 Francis Street. It is onsite, with 40 scheduled weekly hours and a variable rotating shift. The work takes place in a busy and sometimes stressful hospital and office environment; flexibility and the ability to work independently are required.

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 the ability to work collaboratively and cooperatively with a team and internal and external customers.
Strong organizational skills and the ability to set priorities.
Ability to compile data from concurrent and retrospective medical record reviews 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 in a busy and sometimes stressful hospital and office environment.

Nice To Haves

Bilingual English/Spanish.

Responsibilities

Develop a provisional treatment program and tentative discharge date before or within 24–48 hours of admission, based on discussions with the patient or family, physician team, attending physician, and other team members.
Review daily treatment plans with physicians, nurses, patients, and families to support interdisciplinary communication and coordination.
Participate in patient care rounds with nursing staff and physicians, contribute to plans of care, and monitor and report patient progress.
Coordinate with other departments to expedite interventions, consultations, treatments, and ancillary services.
Maintain daily continuity with patients to ensure their discharge-related needs are addressed.
Apply utilization management principles and payer contract knowledge to plans of care, and inform physicians and nurses of relevant implications.
Present alternatives to inpatient care to the attending physician, care team, and patient or family based on the assessed level of care and insurance benefits.
Seek consultation from Care Coordination leadership for outlier and potential or actual resource-intensive patients.
Work with internal and external health care providers to facilitate patient care, including post-discharge services.
Contribute to developing, implementing, and monitoring practice guidelines.
Identify case-management learning needs for attending physicians, residents, and nurses and work with service leaders on education plans.
Assess continuing-care needs with other caregivers and coordinate discharge planning for each patient.
Arrange interdisciplinary meetings with patients and families about discharge needs and plans as appropriate.
Ensure patient education consistent with the discharge plan has occurred.
Identify service, treatment, and funding options for post-hospital care.
Promote patient and family communication and documentation that support discharge planning, aiming to finalize plans the day before discharge.
Follow up with patients and families after discharge to monitor and support desired outcomes.
Contact home health agencies and extended care facilities to facilitate prompt, effective transitions of care.
Identify patients likely to have unmet insurance or resource needs and communicate with or refer them to appropriate care team members and departments.
Communicate with third-party payers about patient progress with treatment plans as needed.
Identify and issue Medicare notices of non-coverage, documenting the process and communications with patients, families, and care team members.
Use industry-accepted utilization or medical management criteria, including InterQual, to identify, monitor, and report variances related to admission appropriateness, continued stay, treatment delays, and discharge plans.
Conduct and document utilization reviews for insurers or intermediaries.
Identify SNF and AND days for Medicare and Medicaid patients.
Take concurrent action to reduce or eliminate inappropriate admissions and hospital days, as well as system delays.
Work with payers and physicians to address level-of-care concerns that affect claims and reimbursement.
Review utilization reports with colleagues and provide feedback on utilization trends and payer issues to support improvement efforts.
Serve as the primary source of patient information for third-party payers.