Brigham and Women's Hospital
RN Care Coordinator (Case Manager) BWH
Brigham and Women's Hospital, Boston, Massachusetts, us, 02298
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Site: The Brigham and Women's Hospital, Inc.
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: 40HR VARIABLE ROTATING
Job Summary
GENERAL SUMMARY The RN Care Coordinator (RNCC) manages a caseload of patients and is responsible for ensuring care that supports desired clinical and financial outcomes. Has the skills and knowledge specific to the unique needs of assigned patients. Coordinating the care prescribed by an interdisciplinary team, the RNCC utilizes patient assessment, care guidelines, protocols, payer regulations and response to therapies to assess the episode of illness from pre admission to post discharge. Participates in the ongoing evaluation of practice patterns and systems and supports efforts to improve quality, cost and satisfaction outcomes. Mobilizes resources to maximize efficiency of care delivery. Principal Duties And Responsibilities
Care Facilitation: Coordinates and insures implementation of the plan of care, utilizing case management principles. Within 24-48 hours of admission, the RNCC interviews the patient/family, discusses with the physician team and/or attending MD, and develops a provisional treatment program and tentative discharge date. Reviews daily treatment plan with physicians, nurses and patient / families to ensure interdisciplinary communication and coordination. Participates in patient care rounds with nursing staff and physicians to contribute to the plan of care and monitor and report patient progress. Collaborates with other departments to expedite sequencing and scheduling of interventions, consults, treatments and ancillary services. Provides daily continuity with patients to assure patient needs related to discharge are met. Incorporates knowledge of utilization management principles and payer contracts into patient plans of care. Keeps physicians and nurses informed of implications. Presents alternatives to inpatient stay to attending MD, team and patient / family based on assessed patient level of care and insurance benefits. Seeks assistance and/or consultation from Care Coordination leadership with plans for outlier and potential or actual resource intensive patients. Interacts with internal and external health care providers to facilitate patient care including post discharge services. Contributes to the development, implementation and monitoring of practice guidelines. Identifies attending, resident and nurse learning needs related to case management and works with service leaders to develop educational plan. Discharge Planning
Coordinates and executes the discharge planning process for patients, ensuring each patient has a discharge plan. Assesses continuing care needs in conjunction with other caregivers; coordinates and schedules interdisciplinary meetings with the patient and family regarding discharge needs and plan; ensures patient education consistent with discharge plan has occurred; identifies service, treatment and funding options for post-hospital care; promotes interdisciplinary patient/family communications and documentation; performs patient/family follow-up after discharge; initiates contact with home health agencies and extended care facilities. Utilization Management
Collaborates with individuals, departments, and payers to ensure appropriateness of admission, continued days of stay, and reimbursement. Identifies patients likely to have unmet insurance and resource needs; communicates with third party payers regarding patient’s progress; issues Medicare notices of non-coverage; conducts utilization reviews; identifies SNF and AD days for Medicare and Medicaid patients; initiates actions to reduce inappropriate hospital admissions and days; works with payers and physicians to address level of care concerns; contributes to utilization and practice improvement efforts; serves as 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 is required for newly licensed nurses and external candidates. 1+ years of acute care experience required. 1 year inpatient acute hospital Case management experience required. Previous experience in a hospital or health care setting; bilingual (English/Spanish) preferred; strong clinical assessment skills; excellent interpersonal skills; strong organizational skill and ability to set priorities; ability to compile data from concurrent and retrospective medical record review; skill to negotiate aspects of care coordination; 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. 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 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.
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GENERAL SUMMARY The RN Care Coordinator (RNCC) manages a caseload of patients and is responsible for ensuring care that supports desired clinical and financial outcomes. Has the skills and knowledge specific to the unique needs of assigned patients. Coordinating the care prescribed by an interdisciplinary team, the RNCC utilizes patient assessment, care guidelines, protocols, payer regulations and response to therapies to assess the episode of illness from pre admission to post discharge. Participates in the ongoing evaluation of practice patterns and systems and supports efforts to improve quality, cost and satisfaction outcomes. Mobilizes resources to maximize efficiency of care delivery. Principal Duties And Responsibilities
Care Facilitation: Coordinates and insures implementation of the plan of care, utilizing case management principles. Within 24-48 hours of admission, the RNCC interviews the patient/family, discusses with the physician team and/or attending MD, and develops a provisional treatment program and tentative discharge date. Reviews daily treatment plan with physicians, nurses and patient / families to ensure interdisciplinary communication and coordination. Participates in patient care rounds with nursing staff and physicians to contribute to the plan of care and monitor and report patient progress. Collaborates with other departments to expedite sequencing and scheduling of interventions, consults, treatments and ancillary services. Provides daily continuity with patients to assure patient needs related to discharge are met. Incorporates knowledge of utilization management principles and payer contracts into patient plans of care. Keeps physicians and nurses informed of implications. Presents alternatives to inpatient stay to attending MD, team and patient / family based on assessed patient level of care and insurance benefits. Seeks assistance and/or consultation from Care Coordination leadership with plans for outlier and potential or actual resource intensive patients. Interacts with internal and external health care providers to facilitate patient care including post discharge services. Contributes to the development, implementation and monitoring of practice guidelines. Identifies attending, resident and nurse learning needs related to case management and works with service leaders to develop educational plan. Discharge Planning
Coordinates and executes the discharge planning process for patients, ensuring each patient has a discharge plan. Assesses continuing care needs in conjunction with other caregivers; coordinates and schedules interdisciplinary meetings with the patient and family regarding discharge needs and plan; ensures patient education consistent with discharge plan has occurred; identifies service, treatment and funding options for post-hospital care; promotes interdisciplinary patient/family communications and documentation; performs patient/family follow-up after discharge; initiates contact with home health agencies and extended care facilities. Utilization Management
Collaborates with individuals, departments, and payers to ensure appropriateness of admission, continued days of stay, and reimbursement. Identifies patients likely to have unmet insurance and resource needs; communicates with third party payers regarding patient’s progress; issues Medicare notices of non-coverage; conducts utilization reviews; identifies SNF and AD days for Medicare and Medicaid patients; initiates actions to reduce inappropriate hospital admissions and days; works with payers and physicians to address level of care concerns; contributes to utilization and practice improvement efforts; serves as 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 is required for newly licensed nurses and external candidates. 1+ years of acute care experience required. 1 year inpatient acute hospital Case management experience required. Previous experience in a hospital or health care setting; bilingual (English/Spanish) preferred; strong clinical assessment skills; excellent interpersonal skills; strong organizational skill and ability to set priorities; ability to compile data from concurrent and retrospective medical record review; skill to negotiate aspects of care coordination; 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. 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 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.
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