RN Case Manager, Home Hospital

Mass General Brigham•Newton, MA

1d•Hybrid

About The Position

Mass General Brigham’s Home Hospital program is redefining how and where acute care is delivered. We provide hospital-level care to medically complex adult patients—in the comfort of their own homes—using advanced clinical models, interdisciplinary collaboration, and innovative technology. We are seeking an experienced RN Case Manager to coordinate care, manage utilization, and support safe transitions across the continuum for patients admitted to Home Hospital. The RN Case Manager partners closely with the healthcare team, payers, patients, families, and community-based organizations to coordinate care and develop and implement individualized discharge plans. This role is ideal for an experienced RN who enjoys critical thinking, autonomy, and working at the forefront of healthcare transformation. Home Hospital cares for adult patients with a range of acute conditions, including heart failure, COPD exacerbations, pneumonia, cellulitis, and specialty populations such as those experiencing postpartum hypertension or cirrhosis. This is a full-time (40 hours/week) role designed to support work–life balance, with a four-day, 10-hour schedule (7:30 AM – 6:00 PM, subject to change) and participation in a weekend rotation. The position is primarily remote, allowing you to work from home while staying closely connected to a highly collaborative interdisciplinary care team. This position offers a flexible, supportive work environment within an innovative care model. Occasional on-site time may be required for training or team meetings at Home Hospital office locations. This position is represented by the Massachusetts Nurses Association collective bargaining unit.

Requirements

Graduate of an accredited school of nursing (BSN preferred).
Current Registered Nurse licensure in the Commonwealth of Massachusetts.
At least three years of clinical nursing experience is strongly preferred.
A minimum of two years of experience in case management, utilization review, or discharge planning is strongly preferred.
Demonstrates strong clinical judgment and independent decision-making abilities.
Effectively collaborates within a multidisciplinary care team.
Uses logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
Establishes strong rapport and relationships with patients, caregivers, and team members.
Manages time effectively, especially when working remotely from the care team.
Proficient in Microsoft Office, Teams, 4Next, Interqual, and other industry-related software programs.

Nice To Haves

CCM or ACMA certification is preferred.
Graduate of an accredited school of nursing (BSN preferred).
At least three years of clinical nursing experience is strongly preferred.
A minimum of two years of experience in case management, utilization review, or discharge planning is strongly preferred.

Responsibilities

Identify patients who would benefit from case management services by utilizing high-risk screening criteria.
Perform comprehensive assessments that address the patient's medical condition, functional status, psychosocial needs, and discharge planning requirements, thereby enhancing patient care throughout the continuum.
Employ a collaborative process of assessment, planning, implementation, care coordination, monitoring, advocacy, and evaluation to meet the individual’s health care needs
Meets patients’ needs efficiently and effectively by enhancing the patient experience, upholding institutional standards for high-quality care, optimizing resource utilization, and supporting appropriate reimbursement.
Coordinate post-acute services, community resources, and follow-up care to facilitate safe and effective patient transitions.
Collaborate with the interdisciplinary care team to assess medical necessity and determine appropriate levels of care.
Conduct admission and concurrent utilization reviews using approved clinical criteria.
Complete timely and accurate insurance reviews and secure required third-party payer authorizations as required.
Identify and address any service delays or inappropriate utilization of healthcare resources.
Support initiatives to reduce readmissions by enhancing care coordination, communication, and follow-up processes.
Educate patients and families about care plans, insurance coverage, and available post-acute care options.
Ensure compliance with federal and state regulations related to discharge planning, including adherence to CMS regulations and organizational policies.
Document assessments, care plans, and ongoing case management activities in accordance with organizational policy and regulatory requirements.
Participate in quality improvement projects, audits, and special assignments as needed.