RN Care Coordinator (Case Manager) BWH

Mass General Brigham•Boston, MA

21h•$42 - $106•Onsite

About The Position

The RN Care Coordinator (RNCC) manages a caseload of patients and is responsible for ensuring care that supports desired clinical and financial outcomes. Has the skills and knowledge specific to the unique needs of assigned patients. Coordinating the care prescribed by an interdisciplinary team, the RNCC utilizes patient assessment, care guidelines, protocols, payer regulations and response to therapies to assess the episode of illness from pre admission to post discharge. Participates in the ongoing evaluation of practice patterns and systems and supports efforts to improve quality, cost and satisfaction outcomes. Mobilizes resources to maximize efficiency of care delivery.

Requirements

Graduate of an approved school of nursing with current registration in Massachusetts.
Bachelor of Science Degree in Nursing is required for newly licensed nurses and external candidates.
1+ years of acute care experience required.
1 year inpatient acute case management experience required.
Strong clinical assessment skills.
Excellent interpersonal skills including ability to work collaboratively and cooperatively within a team and with internal and external customers.
Strong organizational skill and ability to set priorities.
Ability to compile data from concurrent and retrospective medical record review to determine clinical appropriateness.
Able to demonstrate the ability to meet a patient’s needs based on their clinical diagnosis, level of care and discharge plan.
Ability to negotiate several aspects of care coordination simultaneously.
Excellent written and verbal communication skills.

Nice To Haves

Bilingual (English/Spanish) preferred.

Responsibilities

Coordinates and insures implementation of the plan of care, utilizing case management principles.
Develops a provisional treatment program and tentative discharge date within 24-48 hours of admission.
Reviews daily treatment plan with physicians, nurses and patient/families to ensure interdisciplinary communication and coordination.
Participates in patient care rounds to contribute to the plan of care and monitor patient progress.
Collaborates with other departments to expedite sequencing and scheduling of interventions, consults, treatments, and ancillary services.
Provides for daily continuity with patients to assure discharge-related needs are met.
Incorporates knowledge of utilization management principles and payer contracts into patient plans of care.
Presents alternatives to inpatient stay to attending MD, team, and patient/family based on assessed patient level of care and insurance benefits.
Seeks assistance and/or consultation from Care Coordination leadership for outlier and resource-intensive patients.
Interacts with internal and external healthcare providers to facilitate patient care, including post-discharge services.
Contributes to the development, implementation, and monitoring of practice guidelines.
Identifies learning needs related to case management for attending physicians, residents, and nurses and works with service leaders to develop an educational plan.
Coordinates and executes the discharge planning process for patients, ensuring each patient has a discharge plan.
Assesses continuing care needs in conjunction with other caregivers.
Coordinates and schedules interdisciplinary meetings with the patient and family regarding discharge needs and plan.
Assures patient education consistent with the discharge plan has occurred.
Identifies service, treatment, and funding options for post-hospital care.
Promotes interdisciplinary patient/family communications and documentation that facilitate discharge planning, striving to finalize plans the day prior to discharge.
Performs patient/family follow-up after discharge to monitor and support desired outcomes.
Initiates contact with home health agencies and extended care facilities to ensure prompt and effective transition of care.
Collaborates with appropriate individuals, departments, and payers to ensure appropriateness of admission, continued days of stay, and reimbursement.
Identifies patients likely to have unmet insurance and resource needs and communicates with or makes referrals to other members of the healthcare team and appropriate departments.
Communicates with third-party payers regarding patient progress with treatment plan.
Identifies and issues Medicare notices of non-coverage, providing appropriate documentation.
Utilizes industry-accepted utilization and/or medical management criteria (InterQual) to identify, monitor, and report variances from the established treatment plan.
Conducts documented utilization reviews to insurers or intermediaries.
Identifies SNF and AND days for Medicare and Medicaid patients.
Initiates actions concurrently to reduce or eliminate inappropriate hospital admissions and days, and system delays.
Works with payers and physicians to concurrently address level of care concerns affecting claims and reimbursement.
Contributes to utilization and practice improvement efforts by reviewing reports with colleagues and providing feedback on utilization trends and payer issues.
Serves as the primary patient information source to third-party payers.