Massachusetts General Hospital
RN Care Coordinator (Case Manager) BWH
Massachusetts General Hospital, Boston, Massachusetts, us, 02298
Overview
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.
Shift & Work Location
Shift: 40 hr variable rotation
Remote Type: Onsite
Work Location: 45 Francis Street
Scheduled Weekly Hours: 40
Employee Type: Regular
Work Shift: Rotating (United States of America)
Pay Range: $41.71 - $105.65/Hourly
Grade: MNA333
Job Summary RN Care Coordinator (Case Manager)
manages a caseload of patients and is responsible for ensuring care that supports desired clinical and financial outcomes. Utilizing patient assessment, care guidelines, protocols, payer regulations, and response to therapies, the RNCC coordinates interdisciplinary care from pre-admission to post-discharge, participates in evaluating practice patterns, and supports quality, cost, and satisfaction improvements.
Principal Duties & Responsibilities
A. Care Facilitation
Prior to or within 24-48 hrs of admission, develop a provisional treatment program and tentative discharge date via patient/family interview and physician team discussion.
Review daily treatment plan with physicians, nurses, and patient/family to insure interdisciplinary communication.
Participate with nursing staff and physicians in patient care rounds to contribute to plan of care and monitor patient progress.
Collaborate with other departments to expedite sequencing and scheduling of interventions, consults, treatments, and ancillary services.
Provide daily continuity with patients to assure patient needs related to discharge are met.
Incorporate utilization management principles and payer contracts into patient plans of care.
Present alternatives to inpatient stay to attending MD, team, and patient/family based on assessed patient level of care and insurance benefits.
Seek assistance and/or consultation from Care Coordination leadership for outlier or potential/actual resource-intensive patients.
Interact with internal and external health care providers to facilitate patient care including post-discharge services.
Contribute to the development, implementation, and monitoring of practice guidelines.
Identify attending, resident, and nurse learning needs related to case management and work with service leaders to develop an educational plan.
B. Discharge Planning
Coordinate and execute the discharge planning process for patients, ensuring each patient has a discharge plan.
Assess continuing care needs in conjunction with other caregivers.
Coordinate and schedule interdisciplinary meetings with the patient and family regarding discharge needs and plan as appropriate.
Assure patient education consistent with discharge plan has occurred.
Identify service, treatment, and funding options for post-hospital care.
Promote interdisciplinary patient/family communications and documentation that facilitate discharge planning, striving to finalize plans the day prior to discharge.
Perform patient/family follow-up after discharge to monitor and support desired outcomes.
Initiate contact with home health agencies and extended care facilities to insure prompt and effective transition of care.
C. Utilization Management
Collaborate with appropriate individuals, departments, and payers to ensure appropriateness of admission, continued days of stay, and reimbursement.
Identify patients likely to have unmet insurance and resource needs and communicate with the team.
Communicate as needed with third-party payers regarding patient progress with the treatment plan.
Identify need for and issue Medicare notices of non-coverage, providing appropriate documentation of the process and communication to patient/family and other team members.
Utilizing InterQual criteria, identify, monitor, and report variances from established treatment plans, including appropriateness of admission, continued stay, delays in treatment, and discharge plan.
Conduct documented utilization reviews to insurers or intermediaries.
Identify SNF and AND days for Medicare and Medicaid patients.
Initiate actions concurrently to reduce and/or eliminate inappropriate hospital admissions and days, and system delays.
Work with payers and physicians to concurrently address level of care concerns effecting claims and reimbursement.
Contribute to utilization and practice improvement efforts by reviewing reports with colleagues and providing feedback on utilization trends and payer issues.
Serve as the primary patient information source to third-party payers.
Qualifications
Graduate of an approved school of nursing with current registration in Massachusetts.
Bachelor of Science Degree in Nursing required for newly licensed nurses and external candidates.
1+ years of acute care experience required.
1 year inpatient acute hospital case management experience required.
Skills and Abilities
– Previous experience in a hospital or health care setting; bilingual (English/Spanish) preferred; strong clinical assessment skills; excellent interpersonal skills including ability to work collaboratively and cooperatively within a team and with internal and external customers; strong organizational skill and ability to set priorities; ability to compile data from concurrent and retrospective medical record review to determine clinical appropriateness; ability to meet a patient’s needs based on clinical diagnosis, level of care, and discharge plan; ability to negotiate several aspects of care coordination simultaneously; excellent written and verbal communication skills.
Working Conditions Works in a busy and at times stressful hospital and office environment. Must be flexible and able to work well independently.
EEO Statement The Brigham and Women’s Hospital, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.
Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People‑Focused, half Performance‑Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
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Shift & Work Location
Shift: 40 hr variable rotation
Remote Type: Onsite
Work Location: 45 Francis Street
Scheduled Weekly Hours: 40
Employee Type: Regular
Work Shift: Rotating (United States of America)
Pay Range: $41.71 - $105.65/Hourly
Grade: MNA333
Job Summary RN Care Coordinator (Case Manager)
manages a caseload of patients and is responsible for ensuring care that supports desired clinical and financial outcomes. Utilizing patient assessment, care guidelines, protocols, payer regulations, and response to therapies, the RNCC coordinates interdisciplinary care from pre-admission to post-discharge, participates in evaluating practice patterns, and supports quality, cost, and satisfaction improvements.
Principal Duties & Responsibilities
A. Care Facilitation
Prior to or within 24-48 hrs of admission, develop a provisional treatment program and tentative discharge date via patient/family interview and physician team discussion.
Review daily treatment plan with physicians, nurses, and patient/family to insure interdisciplinary communication.
Participate with nursing staff and physicians in patient care rounds to contribute to plan of care and monitor patient progress.
Collaborate with other departments to expedite sequencing and scheduling of interventions, consults, treatments, and ancillary services.
Provide daily continuity with patients to assure patient needs related to discharge are met.
Incorporate utilization management principles and payer contracts into patient plans of care.
Present alternatives to inpatient stay to attending MD, team, and patient/family based on assessed patient level of care and insurance benefits.
Seek assistance and/or consultation from Care Coordination leadership for outlier or potential/actual resource-intensive patients.
Interact with internal and external health care providers to facilitate patient care including post-discharge services.
Contribute to the development, implementation, and monitoring of practice guidelines.
Identify attending, resident, and nurse learning needs related to case management and work with service leaders to develop an educational plan.
B. Discharge Planning
Coordinate and execute the discharge planning process for patients, ensuring each patient has a discharge plan.
Assess continuing care needs in conjunction with other caregivers.
Coordinate and schedule interdisciplinary meetings with the patient and family regarding discharge needs and plan as appropriate.
Assure patient education consistent with discharge plan has occurred.
Identify service, treatment, and funding options for post-hospital care.
Promote interdisciplinary patient/family communications and documentation that facilitate discharge planning, striving to finalize plans the day prior to discharge.
Perform patient/family follow-up after discharge to monitor and support desired outcomes.
Initiate contact with home health agencies and extended care facilities to insure prompt and effective transition of care.
C. Utilization Management
Collaborate with appropriate individuals, departments, and payers to ensure appropriateness of admission, continued days of stay, and reimbursement.
Identify patients likely to have unmet insurance and resource needs and communicate with the team.
Communicate as needed with third-party payers regarding patient progress with the treatment plan.
Identify need for and issue Medicare notices of non-coverage, providing appropriate documentation of the process and communication to patient/family and other team members.
Utilizing InterQual criteria, identify, monitor, and report variances from established treatment plans, including appropriateness of admission, continued stay, delays in treatment, and discharge plan.
Conduct documented utilization reviews to insurers or intermediaries.
Identify SNF and AND days for Medicare and Medicaid patients.
Initiate actions concurrently to reduce and/or eliminate inappropriate hospital admissions and days, and system delays.
Work with payers and physicians to concurrently address level of care concerns effecting claims and reimbursement.
Contribute to utilization and practice improvement efforts by reviewing reports with colleagues and providing feedback on utilization trends and payer issues.
Serve as the primary patient information source to third-party payers.
Qualifications
Graduate of an approved school of nursing with current registration in Massachusetts.
Bachelor of Science Degree in Nursing required for newly licensed nurses and external candidates.
1+ years of acute care experience required.
1 year inpatient acute hospital case management experience required.
Skills and Abilities
– Previous experience in a hospital or health care setting; bilingual (English/Spanish) preferred; strong clinical assessment skills; excellent interpersonal skills including ability to work collaboratively and cooperatively within a team and with internal and external customers; strong organizational skill and ability to set priorities; ability to compile data from concurrent and retrospective medical record review to determine clinical appropriateness; ability to meet a patient’s needs based on clinical diagnosis, level of care, and discharge plan; ability to negotiate several aspects of care coordination simultaneously; excellent written and verbal communication skills.
Working Conditions Works in a busy and at times stressful hospital and office environment. Must be flexible and able to work well independently.
EEO Statement The Brigham and Women’s Hospital, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.
Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People‑Focused, half Performance‑Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
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