RN, Case Manager, 40hrs. Days

About the role

Everyone Is a Caregiver 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 we can help you build the career you deserve.

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.
• Makes meetings with 3rd party case managers to discuss cases and assure timely communication of relevant clinical information to third party payers as required.
• Collaboratively facilitates the care of patients throughout the continuum of care.
• Works as a team member to support /collaborate with 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 the 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.
• Negotiates 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.
• Continually evaluates the patient’s level of care.
• Educates the patient, family and care team regarding resource options, facilitates decision making, initiates plans, 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.

Qualifications

• License/Certification/Education Required: Massachusetts licensure as a registered nurse.
• Experience/Skills Required: Three (3) years clinical experience in discharge planning or case management. Ability to effectively use specialized computer-based systems for the gathering, reporting, and analysis of clinical data. Excellent organizational and communications skills.

Benefits

Exemption Status Exempt
Hiring Range $86,964.80 - $156,520.00
Please note that the final offer may vary within this range based on a candidate’s experience, skills, qualifications, and internal equity considerations.

Pay

Schedule Details Sunday through Saturday
Scheduled Hours 0800 - 1630
Shift 1 - Day Shift, 8 Hours (United States of America)

Schedule

Hours 40

Cost Center

24030 - 4404

Discharge Planning

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

Physical Demands and Environmental Conditions

• Working indoors Frequently Sitting, standing, walking, reaching, grasping, repetitive movements, high stress level, color vision Precise motor skills, hearing, vision Lifting, carrying, pulling, pushing 0-10 pounds Occasionally Pushing, pulling, twisting, climbing, balancing, bending, kneeling, temperature extremes, kneeling Lifting, carrying, pulling, pushing 10-20 pounds

Equal Opportunity Employer

We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

Contact Information

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.