Nurse Case Manager - Care Transitions (Full Time)

Job Description

Essential Duties & Responsibilities:

• Performs utilization review and discharge planning to inpatient admissions.
• Applies Interqual, AEP and or other review criteria approved by the Clinic to accurately determine appropriateness for inpatient and outpatient care.
• Utilizes clinical expertise to determine the appropriate level of care for patients.
• Led the healthcare team in selecting appropriate, safe, hospital or alternative care options.
• Works closely with Community Case Managers to collaborate regarding medically fragile and or high risk patients admitted to the clinic.
• Identifies delay days and notifies Team Leader.
• Reports serious occurrences and sentinel events to Risk Management.
• Works with patients and families to facilitate post hospital care and develop plans to meet short and long-term needs.
• Accurately manages observation status patients by working with physicians to ensure appropriate utilization.
• Is part of the department’s Saturday, Sunday, holiday and beeper rotation as needed.
• Supports all service line activities related to utilization and quality management.
• Assists in the development and implementation of clinical pathways.
• Adheres to all insurance, contractual and regulatory requirements as mandated.
• Works with Lahey Clinic nursing, social work and other members of the healthcare team to coordinate and facilitate patient discharge.
• Works with the Post Acute Care Coordinator to facilitate timely patient access to post acute care Services.
• Participates in hospital or medical committees representing patient issues and department functions such as case management, utilization and CQI as requested.
• Incorporates Lahey Clinic Guiding Principles , Mission Statement and Goals into daily activities.
• Complies with all Lahey Clinic Policies.
• Complies with behavioral expectations of the department and Lahey Clinic.
• Maintains courteous and effective interactions with colleagues and patients.
• Demonstrates an understanding of the job description, performance expectations, and competency assessment.
• Demonstrates a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
• Participates in departmental and/or interdepartmental quality improvement activities.
• Participates in and successfully completes Mandatory Education.
• Performs all other duties as needed or directed to meet the needs of the department.

Education

• Registered Nurse, Bachelors Degree or commensurate experience preferred.

Experience

• A minimum of three years of medical/surgical nursing care experience.
• Two years of case management or utilization management experience desirable.

Pay Range

$38.11 - $98.23