RN Case Manager (Per Diem)

BMC Software•Brockton, MA

2d•$40 - $58

About The Position

The RN Case Manager (CM) is responsible for overseeing the appropriate level of care and collaborates with the Social Work partner regarding discharge planning with a particular focus on medically complex discharge planning. The RN CM will be assigned to selected areas of the Hospital based upon department staffing and coverage. The RN CM will collaborate with SW Care Coordinator as a team to meet the needs of the patients within unit assigned. As this is an evolving position, duties and responsibilities may vary based on specific assignments and additional tasks may be added as the position is further developed. Each staff member will participate in a departmental orientation focused on Case Management Standards of Practice. All staff will be cross-trained and oriented to the ED Case Management Practice.

Requirements

Graduate of an approved school of nursing.
Recent experience in acute care setting involved with clinical activities and/or a managed care environment working in case management, recent experience in a case management role or related role
Active MA RN license
Excellent computer skills including managing work against performance metrics and reporting on key indicators important to the department
Strong computer skills with knowledge and proficiency with Microsoft Word, Excel and PowerPoint
Demonstrated data analytic skills.
Demonstrated skills in working collaboratively with physicians, managers and other team members
Demonstrated skills in organizing and facilitating interdisciplinary teams to ensure timely discharge
Evidence of continued professional development

Nice To Haves

BSN
InterQual experience
Case Management certification preferred

Responsibilities

UM Reviews and Denial Support
Discharge Planning and Execution
Maintain daily tracking tools to support data reporting
Support the Care Coordination Manager/Director in maintaining the financial and clinical outcomes of the Care Coordination Department.
Support the BMC South physician network by coordinating with the BMC South ambulatory/community care coordinators to ensure patient information is communicated and the transitions of care from inpatient to outpatient is planned and in place.
Identify opportunities to educate physicians on areas requiring documentation improvement and/or other improvements.
Ensure that resources are managed in a cost-effective manner while achieving positive clinical outcome
Identify service needs, systems issues and opportunities for improvement for the Department
Participate in the Hospital Quality Improvement Plan through unit and/or divisional quality control/quality improvement activities.
Report deviations in quality care to the Manager/Director of Care Coordination.
Assist with the development of clinical guidelines, as needed.
Maintain current knowledge of regulatory requirements including changes to payer requirements, reporting and regulatory requirements.
Demonstrate effective leadership skill
Attend weekly Care Coordination meetings, when scheduled to work.
Complete all paperwork required for regulations e.g., LTCF, OBRA screening, Condition/Code 44 paperwork.
Perform InterQual reviews on assigned patients and working with insurers to provide clinical information, answer questions, obtain insurance authorization for patients.
Collaborate with Social Worker (SW) Care Coordinators on the units who will be responsible for the development and execution of patient discharge plans.
Coordinate with the SW Care Coordinators for clinically difficult discharge plans.
Review reports on the Department's performance including but not limited to: LOS, clinical denials and appeal status, avoidable days, time of discharge, proper level of documentation.
Work with Care Coordination Manager/Director to develop educational needs and identify strategies to accomplish objectives of the Department