RN Care Coordinator-Complex Case Manager

BMC Software•Boston, MA

3d•$85,176 - $196,747•Onsite

About The Position

The RN Care Coordinator-Complex Case Manager will be responsible for managing complex cases within the Care Management department. This role requires a strong clinical background and experience in judgment and decision-making, particularly in utilization management and case management. The position involves working with patients, physicians, payers, and senior leadership to develop and implement treatment plans, ensure quality care, and manage costs. The goal is to provide exceptional and equitable care to all patients, aligning with Boston Medical Center's mission.

Requirements

A minimum of 3-5 years of diversified clinical experience is required.
A minimum of 2 years of previous experience involving judgment and decision making, preferably in a utilization management/case management position.
A minimum of 3-5 years recent clinical experience required.
1-3 years of recent acute, Inpatient Care Management experience required.
Ability to understand confidentiality and the legal and ethical issues pertaining to patient health.
Ability to understand medical terminology, how to obtain an accurate history, and establish treatment goals.
Ability to establish working relationships with referral sources and develop treatment plans.
Knowledge and understanding of methods for assessing an individual's level of physical/mental impairment.
Understanding of the physical and psychological characteristics of illness.
Ability to assist individuals with the development of short- and long-term health goals.
Ability to understand the requirements for prior approval by payer.
Ability to evaluate the quality of necessary medical services.
Ability to acquire and analyze the cost of care.
Understanding of the various health care delivery systems and payer plan contracts.
Ability to demonstrate cost savings.
Ability to understand case management philosophy and principles.
Ability to apply problem solving techniques to the care management process.
Ability to document care management services.
Understanding of liability issues for care management activities.
Knowledgeable on how to access and evaluate the available resources to meet a client's needs.
Ability to develop new resources.
Excellent interpersonal, verbal, and written communication and negotiation skills.
Strong analytical, data management and PC skills.
Current working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement.
Understanding of pre-acute and post-acute venues of care and post-acute community resources.
Strong organizational and time management skills, as evidenced by a capacity to prioritize multiple tasks and role components.
Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.
Ability to partner with post acute facilities to move patients to the next level of care that are considered long length of stay with difficult dispositions and possible insurance barriers.
Must be vaccinated against COVID-19 and flu, and receive a booster dose of the COVID-19 vaccine.
Must complete a background check.

Nice To Haves

Certification preferred.

Responsibilities

Manage complex cases within the Care Management department.
Understand confidentiality and legal/ethical issues pertaining to patient health.
Understand medical terminology, obtain accurate patient histories, and establish treatment goals.
Establish working relationships with referral sources and develop treatment plans.
Assess an individual's level of physical/mental impairment and understand the characteristics of illness.
Assist individuals with the development of short- and long-term health goals.
Understand prior approval requirements by payers and evaluate the quality of necessary medical services.
Acquire and analyze the cost of care, understanding various healthcare delivery systems and payer plan contracts.
Demonstrate cost savings.
Apply case management philosophy and principles, using problem-solving techniques.
Document care management services and understand liability issues.
Access and evaluate available resources to meet client needs and develop new resources.
Partner with post-acute facilities to move patients to the next level of care, especially those with long lengths of stay, difficult dispositions, and potential insurance barriers.
Work with the Director and senior leadership team to develop solutions for patients and propose them to senior leadership.
Perform any other duties assigned by the hospital, department, or director.