RN Case Manager for Dual Eligible Special Need Plan (D-SNP)

Brigham and Women's Hospital-posted 2 months ago
$58,656 - $142,449/Yr
Full-time • Mid Level
Hybrid • Braintree, MA
5,001-10,000 employees
Hospitals
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Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. The Opportunity The RN Case Manager serves as a core member of the care team by coordinating and supporting healthcare within the facility and coordinating referrals for services outside the clinic. The RN provides outreach and enrollment services to meet eligibility requirements of the program and surrounding counties, and ensures coordination and planning, including community and family support, by focusing on the development and coordination of community service plans and partnering with service providers, families, and patients to create a plan of healthcare.

  • Conduct client assessments and planning.
  • Modify patient treatment plans as indicated by patients' responses and conditions.
  • Prepare patient/family for discharge.
  • Communicate with third party payers to obtain necessary authorization for reimbursement of services.
  • Define care goals of patients by providing education, information, and direction to each individual and family.
  • Review cases with medical directors on challenging cases as needed.
  • Maintain accurate, detailed reports and records.
  • Associate's Degree Nursing required (Bachelor's Degree Nursing preferred).
  • Active and unrestricted Registered Nurse (RN) Licensure for the state of Massachusetts required.
  • 2+ years of case management and/or discharge planning required.
  • Experience working with complex dually eligible populations required.
  • Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
  • Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
  • Ability to establish strong rapport and relationships with patients and staff.
  • Proficient in Microsoft Office and industry related software programs.
  • Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
  • Ability to maintain client and staff confidentiality.
  • Knowledge of Managed Care preferred.
  • Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care preferred.
  • Utilization Review experience preferred.
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