Brigham and Women's Hospital
RN Care Coordinator (Case Manager) BWH
Brigham and Women's Hospital, Boston, Massachusetts, us, 02298
RN Care Coordinator (Case Manager) – Brigham & Women's Hospital
Location: 45 Francis Street, Boston, MA
Shift: 40 hours variable rotating
Employment type: Regular, Full-time
Job Summary
The RN Care Coordinator manages a caseload of patients, ensuring care that supports desired clinical and financial outcomes. The role leverages patient assessment, interdisciplinary care guidelines, payer regulations, and response to therapies to navigate the episode of illness from pre‑admission to post‑discharge. The RNCC participates in ongoing evaluation of practice patterns, supports quality and cost improvement initiatives, and mobilizes resources to maximize efficiency of care delivery.
Principal Duties and Responsibilities
Care Facilitation: coordinates and assures implementation of the plan of care using case‑management principles.
Within 24‑48 hours of admission: conducts patient/family interviews and reviews with physicians to develop a provisional treatment program and tentative discharge date.
Daily: reviews the treatment plan with physicians, nurses, and patient families to ensure interdisciplinary communication.
Participates in nursing staff and physician care rounds to contribute to the plan of care and monitor patient progress.
Collaborates with other departments to expedite the sequencing and scheduling of interventions, consults, treatments, and ancillary services.
Provides daily continuity with patients to ensure discharge‑related needs are met.
Incorporates utilization‑management principles and payer contract knowledge into patient care plans, informing physicians and nurses of implications.
Presents inpatient alternatives to the attending physician and the patient/family based on clinical and insurance factors.
Seeks assistance or consultation from Care Coordination leadership for outlier or potential resource‑intensive patients.
Interacts with internal and external health‑care providers to facilitate inpatient and post‑discharge services.
Contributes to development, implementation, and monitoring of practice guidelines.
Identifies learning needs for attending, resident, and nursing staff related to case management and collaborates with leaders to develop educational plans.
Discharge Planning:
Assesses continuing care needs with other caregivers.
Coordinates interdisciplinary meetings with patients and families regarding discharge needs and plans.
Ensures patient education consistent with the discharge plan has occurred.
Identifies service, treatment, and funding options for post‑hospital care.
Promotes interdisciplinary communication and documentation to finalize discharge plans the day prior to discharge.
Follows up with patients/families after discharge to monitor outcomes.
Initiates contact with home health agencies and extended‑care facilities to ensure prompt transition of care.
Utilization Management:
Identifies patients likely to have unmet insurance or resource needs and communicates with the care team and relevant departments.
Communicates with third‑party payers regarding patient progress.
Issues Medicare notices of non‑coverage and documents the process.
Uses InterQual criteria to monitor and report variances from the established treatment plan, including admission appropriateness, prolonged stay, delays, and discharge plan compliance.
Conducts documented utilization reviews for insurers or intermediaries.
Identifies SNF and AND days for Medicare and Medicaid patients.
Initiates actions to reduce inappropriate hospital admissions and days, addressing system delays.
Works with payers and physicians to resolve level‑of‑care concerns affecting claims and reimbursement.
Contributes to utilization and practice improvement by reviewing reports and providing feedback on utilization trends and payer issues.
Serves 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 in Nursing required for newly licensed nurses and external candidates.
1+ years of acute‑care experience required.
1 year of case‑management experience required; inpatient acute hospital case‑management experience preferred.
Skills and competencies: prior hospital or health‑care experience; bilingual English/Spanish preferred; strong clinical assessment, interpersonal, organizational, and prioritization skills; ability to compile data from concurrent and retrospective medical record reviews; ability to negotiate multiple care coordination aspects simultaneously; excellent written and verbal communication skills.
Working Conditions
Works in a busy, sometimes stressful hospital and office environment; must be flexible and able to work well independently.
Remote Type
Onsite
Pay Range
$41.71 – $105.65 per hour 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. The hospital will ensure reasonable accommodations for individuals with disabilities in the application or interview process. For accommodations contact Human Resources at (857)-282-7642.
Mass General Brigham Competency Framework
The competency framework defines effective leadership behaviors across ten competencies (half people‑focused, half performance‑focused). These competencies guide performance evaluation, hiring, development needs, and talent pipeline creation.
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Job Summary
The RN Care Coordinator manages a caseload of patients, ensuring care that supports desired clinical and financial outcomes. The role leverages patient assessment, interdisciplinary care guidelines, payer regulations, and response to therapies to navigate the episode of illness from pre‑admission to post‑discharge. The RNCC participates in ongoing evaluation of practice patterns, supports quality and cost improvement initiatives, and mobilizes resources to maximize efficiency of care delivery.
Principal Duties and Responsibilities
Care Facilitation: coordinates and assures implementation of the plan of care using case‑management principles.
Within 24‑48 hours of admission: conducts patient/family interviews and reviews with physicians to develop a provisional treatment program and tentative discharge date.
Daily: reviews the treatment plan with physicians, nurses, and patient families to ensure interdisciplinary communication.
Participates in nursing staff and physician care rounds to contribute to the plan of care and monitor patient progress.
Collaborates with other departments to expedite the sequencing and scheduling of interventions, consults, treatments, and ancillary services.
Provides daily continuity with patients to ensure discharge‑related needs are met.
Incorporates utilization‑management principles and payer contract knowledge into patient care plans, informing physicians and nurses of implications.
Presents inpatient alternatives to the attending physician and the patient/family based on clinical and insurance factors.
Seeks assistance or consultation from Care Coordination leadership for outlier or potential resource‑intensive patients.
Interacts with internal and external health‑care providers to facilitate inpatient and post‑discharge services.
Contributes to development, implementation, and monitoring of practice guidelines.
Identifies learning needs for attending, resident, and nursing staff related to case management and collaborates with leaders to develop educational plans.
Discharge Planning:
Assesses continuing care needs with other caregivers.
Coordinates interdisciplinary meetings with patients and families regarding discharge needs and plans.
Ensures patient education consistent with the discharge plan has occurred.
Identifies service, treatment, and funding options for post‑hospital care.
Promotes interdisciplinary communication and documentation to finalize discharge plans the day prior to discharge.
Follows up with patients/families after discharge to monitor outcomes.
Initiates contact with home health agencies and extended‑care facilities to ensure prompt transition of care.
Utilization Management:
Identifies patients likely to have unmet insurance or resource needs and communicates with the care team and relevant departments.
Communicates with third‑party payers regarding patient progress.
Issues Medicare notices of non‑coverage and documents the process.
Uses InterQual criteria to monitor and report variances from the established treatment plan, including admission appropriateness, prolonged stay, delays, and discharge plan compliance.
Conducts documented utilization reviews for insurers or intermediaries.
Identifies SNF and AND days for Medicare and Medicaid patients.
Initiates actions to reduce inappropriate hospital admissions and days, addressing system delays.
Works with payers and physicians to resolve level‑of‑care concerns affecting claims and reimbursement.
Contributes to utilization and practice improvement by reviewing reports and providing feedback on utilization trends and payer issues.
Serves 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 in Nursing required for newly licensed nurses and external candidates.
1+ years of acute‑care experience required.
1 year of case‑management experience required; inpatient acute hospital case‑management experience preferred.
Skills and competencies: prior hospital or health‑care experience; bilingual English/Spanish preferred; strong clinical assessment, interpersonal, organizational, and prioritization skills; ability to compile data from concurrent and retrospective medical record reviews; ability to negotiate multiple care coordination aspects simultaneously; excellent written and verbal communication skills.
Working Conditions
Works in a busy, sometimes stressful hospital and office environment; must be flexible and able to work well independently.
Remote Type
Onsite
Pay Range
$41.71 – $105.65 per hour 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. The hospital will ensure reasonable accommodations for individuals with disabilities in the application or interview process. For accommodations contact Human Resources at (857)-282-7642.
Mass General Brigham Competency Framework
The competency framework defines effective leadership behaviors across ten competencies (half people‑focused, half performance‑focused). These competencies guide performance evaluation, hiring, development needs, and talent pipeline creation.
#J-18808-Ljbffr