RN Care Coordinator (Case Manager)

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.

Responsibilities

• Care Facilitation
  • Coordinates and ensures implementation of the plan of care, utilizing case management principles.
  • Within 24-48 hours of admission, develops a provisional treatment program and tentative discharge date through patient/family interviews, physician discussions, and team collaboration.
  • Reviews daily treatment plans with physicians, nurses, and patients/families to ensure interdisciplinary communication and coordination.
  • Participates in patient care rounds to contribute to the plan of care and monitor patient progress.
  • Collaborates with other departments to expedite sequencing and scheduling of interventions, consults, treatments, and ancillary services.
  • Provides daily continuity with patients to address discharge-related needs.
  • Incorporates utilization management principles and payer contracts into patient plans of care and communicates implications to physicians and nurses.
  • Presents alternatives to inpatient stay based on assessed patient level of care and insurance benefits.
  • Seeks consultation from Care Coordination leadership for outlier or resource-intensive patients.
  • Interacts with internal and external healthcare providers to facilitate patient care, including post-discharge services.
  • Contributes to the development, implementation, and monitoring of practice guidelines.
  • Identifies learning needs related to case management and works with service leaders to develop educational plans.
• Discharge Planning
  • Coordinates and executes the discharge planning process, ensuring each patient has a discharge plan.
  • Assesses continuing care needs in conjunction with other caregivers.
  • Coordinates and schedules interdisciplinary meetings with patients and families regarding discharge needs.
  • Ensures patient education consistent with the discharge plan is provided.
  • Identifies service, treatment, and funding options for post-hospital care.
  • Promotes interdisciplinary communication and documentation to finalize discharge plans the day prior to discharge.
  • Performs post-discharge follow-up to monitor and support desired outcomes.
  • Initiates contact with home health agencies and extended care facilities to ensure prompt and effective transition of care.
• Utilization Management
  • Collaborates with individuals, departments, and payers to ensure appropriateness of admission, continued stay, and reimbursement.
  • Identifies patients with unmet insurance and resource needs and communicates with or refers to the healthcare team.
  • Communicates with third-party payers regarding patient progress with the treatment plan.
  • Issues Medicare notices of non-coverage as needed, documenting the process and communication.
  • Utilizes industry-accepted criteria (e.g., InterQual) to identify, monitor, and report variances from the treatment plan.
  • Conducts documented utilization reviews for insurers or intermediaries.
  • Identifies SNF and AND days for Medicare and Medicaid patients.
  • Initiates actions to reduce or eliminate inappropriate hospital admissions, days, and system delays.
  • Works with payers and physicians to address level-of-care concerns affecting claims and reimbursement.
  • Contributes to utilization and practice improvement efforts by reviewing reports and providing feedback on trends and payer issues.
  • Serves as the primary patient information source to third-party payers.

Requirements

• Graduate of an approved school of nursing with current registration in Massachusetts.
• For newly licensed nurses, a Bachelor of Science Degree in Nursing is required.
• 5+ years of acute care experience.
• 1 year of inpatient acute case management experience.

Skills

• Previous experience in a hospital or healthcare setting.
• Bilingual (English/Spanish) preferred.
• Strong clinical assessment skills.
• Excellent interpersonal skills, including the ability to work collaboratively within a team and with internal/external customers.
• Strong organizational skills and ability to set priorities.
• Ability to compile data from medical record reviews to determine clinical appropriateness.
• Demonstrated ability to meet patient needs based on clinical diagnosis, level of care, and discharge plan.
• Ability to negotiate multiple 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.

Schedule

• 40 hours per week, variable rotation.
• Rotating shifts (onsite).

Pay

Hourly pay range: $41.71 - $105.65. Base pay is determined by skills, relevant experience, education, certifications, and other essential factors. In addition to competitive base pay, comprehensive benefits, career advancement opportunities, differentials, premiums, bonuses, and recognition programs are offered.