RN Care Coordinator (Case Manager) BWH

About the role

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. Work Location: 45 Francis Street, Onsite; Employee Type: Regular.

Responsibilities

• Coordinates and ensures implementation of the plan of care, utilizing case management principles.
• Prior to or within 24-48 hours of admission, develops a provisional treatment program and tentative discharge date by interviewing the patient/family, discussing with the physician team and/or attending MD and other team members.
• Reviews daily treatment plan with physicians, nurses and patient/families to ensure interdisciplinary communication and coordination.
• Participates with nursing staff and physicians in patient care rounds to contribute to 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.
• 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 as appropriate.
• Assures 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 that facilitate discharge planning striving to finalize plans the day prior to discharge.
• Performs patient/family follow-up after discharge to monitor and support desired outcomes.
• Initiates contact with home health agencies and extended care facilities to insure prompt and effective transition of care.
• Collaborates with appropriate individuals, departments, and payers to insure appropriateness of admission, continued days of stay, and reimbursement.
• Identifies patients who are likely to have unmet insurance and resource needs and communicates with and/or makes referrals to other members of the health care team and other appropriate departments.
• Communicates as needed with third party payers regarding patient’s progress with treatment plan.
• Identifies need for and issues Medicare notices of non-coverage, providing appropriate documentation of the process and communication to patient/family and other members of the health care team.
• Utilizing industry accepted utilization and/or medical management criteria (InterQual) identifies, monitors and reports variances from established treatment plan, including appropriateness of admission, continued stay, delays in treatment, and discharge plan.
• Conducts documented utilization reviews to insurers or intermediaries.
• Identifies SNF and AND days for Medicare and Medicaid patients.
• Initiates actions concurrently to reduce and/or eliminate inappropriate hospital admissions and days, and system delays.
• Works with payers and physicians to concurrently address level of care concerns affecting claims and reimbursement.
• Contributes to utilization and practice improvement efforts by reviewing reports with colleagues and providing feedback on utilization trends and payer issues.
• Serves as the primary patient information source to third party payers.

Qualifications

Education: 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 required; 1 year of inpatient acute case management experience required.

Skills/Abilities/Competencies Required: Previous experience in a hospital or health care setting; bilingual (English/Spanish) preferred; strong clinical assessment skills; excellent interpersonal skills including ability to work collaboratively and cooperatively within a team and with internal and external customers; strong organizational skill and ability to set priorities; ability to compile data from concurrent and retrospective medical record review to determine clinical appropriateness, able to demonstrate the ability to meet a patient’s needs based on their clinical diagnosis, level of care and discharge plan; ability to negotiate several 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.

Benefits

In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth.

Pay

Pay Range: $41.71 - $105.65/Hourly (Grade MNA333). The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package.

Schedule

Shift: 40hr variable rotation; Scheduled Weekly Hours: 40; Work Shift: Rotating; Work Location: 45 Francis Street, Onsite; Employee Type: Regular.