RN Case Manager

Baystate Health•Springfield, MA

1d•Onsite

About The Position

Baystate Health, a nationally recognized leader in healthcare quality, patient safety, and innovation, is seeking a RN Case Manager to join the Hospital Medicine team at Baystate Medica l Center (BMC) — a Magnet-designated hospital for Nursing Excellence located in Springfield, Massachusetts . The Hospital Case Manager is a registered professional nurse who facilitates and enhances collaboration with patients, families, physicians, and healthcare providers to ensure patients receive the services required to improve healthcare outcomes and quality of life. The Hospital Case Manager seeks to ensure that quality care is provided to patients and actively participates in the process to improve operational efficiency and patient outcomes.

Requirements

Successfully passed Board of Registration in Nursing Examination and is licensed in the Commonwealth of Massachusetts
Current American Heart Association Health Care Provider CPR certification required.
Minimum 3-5 years of recent acute medical-surgical nursing experience
Associates Degree in Nursing (Required)
Bachelors Degree in Nursing
Registered Nurse - State of MassachusettsState of MassachusettsState of Massachusetts

Nice To Haves

1-3 years Case Management
Case Management Certification - OtherOtherOther

Responsibilities

Uses Case Management skills to ensure quality patient-centered care is achieved.
Utilizes effective communication with peers, patients, and families.
Performs daily review of cases and makes appropriate recommendations to the care team for practice guideline utilization, LoS, and quality of care.
Recognizes the case manager's role in assessing, facilitating, collaborating, and coordinating patient services through the continuum of care.
Effectively collaborates with others on the healthcare team to resolve patient care issues.
Applies utilization criteria correctly and responsibly best to portray the care delivery process for all BH hospitals.
Identifies appropriateness of admission and concurrent days of stay.
Provides verbal and written notices of non-coverage to patients and/or their representatives in accordance with departmental policies and third-party regulations
As applicable, communicate effectively and efficiently with insurance companies to avoid the denial/appeal process whenever possible.
Understands the role of the Physician Advisor for Case Management and makes appropriate referrals for review.
Provides a clear and concise review.
Ensures CM leadership is informed on issues of prolonged LOS, patient/family concerns, and insurance payment issues
Provides post-acute hospital care planning/discharge facilitation.
Proactively works with the healthcare team to identify those patients who will need some level of care following their acute hospitalization.
Involves patients/families in the discharge planning process to facilitate a clear understanding by all parties.
Monitors each patient’s discharge plan of care for variance and, makes appropriate recommendations and revises the plan as necessary.
Assures that interventions are in alignment with medical management initiatives.
Provides appropriate financial/regulatory information to patients and/or families including the scope of reimbursement sources.
Follows all state and federal guidelines in regard to patient rights in planning for their post-acute needs.
Demonstrates strong clinical knowledge as part of the healthcare team to ensure quality, evidenced based care is delivered.
Demonstrates strong clinical knowledge in the patient population being managed.
Continually seeks to develop their body of clinical knowledge.
Serves as a resource to members of the healthcare team
Collaborates with community case managers and other health care advisors to ensure a smooth and safe continuum of care plan.
Provides timely documentation of the post-acute care plan in the medical record.
Conducts extensive assessments and implements interventions for patients at risk for readmissions
Active participant in daily unit progression rounds with interdisciplinary teams to direct timely care progression along the continuum, focusing on appropriate GMLOS.
Assumes Responsibility for Own Professional Growth.
Attends educational programs to maintain current knowledge in utilization management, discharge planning, and case management with specific emphasis on own areas of responsibility.
Attends educational programs to maintain knowledge of current clinical management of patient problems on assigned clinical areas.
Establishes annual goals for professional growth and seeks opportunities that lead to the accomplishment of these goals.
Attends regularly scheduled departmental meetings as guided by the department manager and/or supervisor.