4x10 Hour Shifts, Every 6th Weekend)

BMC Software•Boston, MA

1d•$38 - $75

About The Position

Utilizing a collaborative process, the care manager will assess, plan, implement, monitor, and evaluate the options and services required to meet an individual’s health needs, using communication and available resources to promote quality, cost-effective outcomes. The care manager helps identify appropriate providers and facilities throughout the continuum of services while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the patient and the reimbursement source. This care manager is dedicated to handle the increased volume and to support the overall care management process and the department. Are you a collaborative RN who thrives in a fast-paced environment and is passionate about patient-centered care? Join our Care Management team and help patients navigate the healthcare system with efficiency, compassion, and clinical expertise. Position: RN Care Manager Department: Maternity/L&D/NICU-Yawkey Pavilion, Schedule: 40 Hours (Days / 4x10 Hour Shifts, Every 6th Weekend)

Requirements

BSN preferred and MA RN license required
A minimum of 3-5 years recent clinical experience required.
A minimum of 1-3 years recent acute inpatient Care Management experience required.
Strong communication, collaboration, and problem-solving skills
Knowledge of utilization review, discharge planning, managed care, and community resources
Graduate of an accredited BS program in Nursing required.
Licensed to practice professional nursing as a Registered Nurse in the Commonwealth of Massachusetts.
Ability to understand confidentiality and the legal and ethical issues pertaining to patient health; understand medical terminology, how to obtain an accurate history; establish treatment goals; establish working relationships with referral sources; develop treatment plans.
Knowledge and understanding of methods for assessing an individual's level of physical/mental impairment; understand 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; be able to evaluate the quality of necessary medical services; be able to acquire and analyze the cost of care; understand the various health care delivery systems and payer plan contracts; be able to demonstrate cost savings.
Ability to understand case management philosophy and principles; apply problem solving techniques to the care management process; document care management services; understand liability issues for care management activities.
Knowledgeable on how to access and evaluate the available resources to meet a client's needs; able 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.

Nice To Haves

Case Management Certification (CCM) preferred or obtained within 24 months

Responsibilities

Coordinate comprehensive care plans from admission through discharge
Collaborate with providers and multidisciplinary teams to ensure timely, cost-effective care
Identify and address barriers to treatment and discharge
Advocate for patients and optimize resource use across the continuum of care
Monitor length of stay, quality metrics, and compliance with payer requirements
Facilitate referrals for home care, medical equipment, hospice, and other post-acute needs