RN Case Manager - Whittier Rehabilitation Hospital Haverhill TCU

Whittier Health Network•Haverhill, MA

29d

About The Position

Whittier Rehabilitation Hospital - Bradford/Haverhill Case Manager/Discharge Planner 20 Bed Transitional Care/Skilled Nursing Unit Full-Time, 40 hours/week Must be licensed in the State of Massachusetts Primary Responsibilities: To oversee and coordinate each patient's hospital stay beginning with admission through discharge. Work with all members of the interdisciplinary care team to identify goals, address barriers to discharge and ensure patient receives the optimum rehabilitation services in the most efficient manner. Provide the patient and family information about the rehabilitation process, levels of care, and patient rights/responsibilities. Work within the confines of CMS guidelines and/or Managed Care expectations, able to advocate for patients when possible. Ensure patient is provided with appropriate resources befitting next level of care setting (e.g., list of skilled nurse facilities, available home health agencies, etc.). Maintain appropriate patient and family contact regarding patient progress towards goals, care team discussions, as well as continual review of discharge planning efforts to ensure a safe and timely discharge plan is in place. Address disposition changes in timely manner, remaining proactive in anticipating patient's discharge needs.

Requirements

Registered Nurse with 2-5 years acute care case management experience.
Excellent communication (written and verbal), interpersonal and organizational skills.
Ability to assess, analyze, plan, implement and evaluate plan of care.
Basic knowledge of CMS guidelines, Managed Care products, and criteria for inpatient rehab vs. long-term acute hospital admission.

Responsibilities

Oversee and coordinate each patient's hospital stay beginning with admission through discharge.
Work with all members of the interdisciplinary care team to identify goals, address barriers to discharge and ensure patient receives the optimum rehabilitation services in the most efficient manner.
Provide the patient and family information about the rehabilitation process, levels of care, and patient rights/responsibilities.
Work within the confines of CMS guidelines and/or Managed Care expectations, able to advocate for patients when possible.
Ensure patient is provided with appropriate resources befitting next level of care setting (e.g., list of skilled nurse facilities, available home health agencies, etc.).
Maintain appropriate patient and family contact regarding patient progress towards goals, care team discussions, as well as continual review of discharge planning efforts to ensure a safe and timely discharge plan is in place.
Address disposition changes in timely manner, remaining proactive in anticipating patient's discharge needs.