Registered Nurse, Care Coordinator, Per Diem

Exemption Status: Non-Exempt

Hiring Range: $52.50 - $57.50. Please note that the final offer may vary within this range based on a candidate’s experience, skills, qualifications, and internal equity considerations.

Schedule

• Sunday through Saturday
• Scheduled Hours: 7:00am - 5:30pm, 4 shifts per month
• Shift: 4 - Mixed Shift, 10 Hours
• Holidays: One major summer holiday and one major winter holiday

This position may have a signing bonus available; a member of the Recruitment Team will confirm eligibility during the interview process.

About the Role

At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where you can build the career you deserve. We are more than 20,000 employees working together as one health system in a relentless pursuit of healing for our patients, community, and each other.

Responsibilities

• Performs assessment of patient’s physical, functional, and psycho-social needs through the use of screening tools, direct patient and family communication, medical record review, and discussions with other caregivers providing services to the patient.
• Identifies complex patients in need of intensive case management based on established clinical and financial criteria.
• Performs admission and concurrent reviews as assigned.
• Performs inpatient reviews in accordance with payer requirements utilizing clinical criteria sets.
• Meets with 3rd party case managers to discuss cases and assures timely communication of relevant clinical information to third party payers as required.
• Educates practitioners on the level of care and documentation requirements.
• Collaboratively facilitates the care of patients throughout the continuum of care.
• Works as a team member to support/collaborate with the Care Coordination Team for monitoring level of care, and for identification of trends in clinical practices and opportunities for improvement.
• Works with patients and families to establish objectives, goals, and an action plan to meet the patient’s individual needs within the indicated level of care.
• Collaborates with physicians, other care providers, and community resources in the care planning process.
• Contacts third party payer to clarify benefit eligibility, coverage, and available resources for patients.
• May negotiate conversion of benefits for previously non-covered services.
• Researches alternate sources of funding for non-reimbursed services that are part of the patient’s treatment plan.
• Coordinates, implements, monitors, and evaluates outcomes of the discharge plan.
• Evaluates progress of this plan with the discharge planner, patient, family, and the patient’s health care insurer. Goals, interventions, and time frames are revised as needed to assist the patient in achieving optimal health and functionality.
• Continually evaluates the patient’s level of care.
• Educates the patient, family, and care team regarding resource options, facilitates decision making, initiates plan, and secures resources for the patient on an ongoing basis in complex cases.
• Participates in quality improvement on a system level through identification of opportunities for improvement, collection and analysis of data, and participation in the development and application of revised processes.
• Supports departmental and medical center-wide performance improvement programs such as implementation and monitoring of clinical practice guidelines.
• Fosters compliance with regulatory requirements, good practice, and patient care.
• Complies with established departmental policies, procedures, and objectives.
• Attends a variety of meetings, conferences, and seminars as required or directed.
• Demonstrates use of Quality Improvement in daily operations.
• Complies with all health and safety regulations and requirements.
• Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility, and acceptance toward all employees, patients, and visitors.
• Maintains regular, reliable, and predictable attendance.
• Performs other similar and related duties as required or directed.

Qualifications

• Massachusetts licensure as a registered nurse (Required).
• Three (3) years clinical experience in discharge planning or case management (Required). The 3 years of Case Management experience is waived if the RN has successfully completed the Framingham State College Graduate Certificate Nurse Case Management program.
• The ability to effectively use specialized computer-based systems for the gathering, reporting, and analysis of clinical data.
• Excellent organizational and communication skills.
• Utilization management and third-party payer knowledge (Preferred).

Unless certification, licensure, or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Physical Demands and Environmental Conditions

Work is considered sedentary. Position requires work indoors in a normal office environment.