RN Case Manager, Emergency Department - 40h Days Sign on BONUS!

About the role

The RN ED Case Manager works collaboratively with various healthcare professionals and stakeholders to facilitate patient progress through the continuum of care.

Responsibilities

• Assess and coordinate patient progression through the continuum of care
• Early assessment of pre-admission level of care and post-hospital discharge needs
• Review available resources and timely communication with the healthcare team and patient/family/legal representative
• Identify potential admissions or alternative dispositions in the ED
• Determine appropriate admission status (observation vs. inpatient) using standardized criteria
• Initiate and/or complete initial reviews, communicate LOC and/or LOS concerns to the case management team
• Collaborate with providers to assign appropriate level of care (LOC) designation and ensure medical record documentation
• Screen and refer patients for rehabilitation, long-term acute care hospitals, and nursing homes
• Screen and refer patients for home-based care services
• Communicate discharge planning information and/or concerns to the team the next morning
• Initiate referrals to long-term care facilities and ensure appropriate continuity of care information is provided
• Mandatory reporting to regulatory agencies
• Advocate for patients both internally and externally

Requirements

• Graduate of an accredited school of nursing: BSN/MSN preferred
• RN with current Massachusetts license required
• CCM (Certified Case Manager) preferred
• ACMA (Accredited Case Manager) preferred
• Minimum 3-5 years of experience in acute care case management
• Demonstrated skills in utilization review and critical thinking
• Excellent communication skills and positive interpersonal dynamics
• Solid knowledge of insurance plan regulations
• Strong analytical ability to interpret patient-related information
• Ability to use industry accepted utilization and/or medical management criteria
• Experience in Cerner a plus
• Denials management a plus

Skills

• Excellent computer skills to accurately document information
• Ability to sit for long periods of time, stand, reach, and lift up to 15 pounds
• Ability to communicate effectively with all stakeholders, in person and via phone and electronic means
• Ability to interact directly with patients, with potential for direct exposure to patient care activities
• Ability to document and use trackers, analyze charts, and coordinate services within the electronic health record
• Ability to advocate for patients both internally and externally
• Ability to attend and participate professionally in meetings with Hospital leaders, physicians, patients, and families

Benefits

Salary range: $87,015.12 - $135,323.52
The pay range displayed on each job posting reflects the anticipated range for new hires. A successful candidate's actual compensation will be determined after considering factors such as work history, experience, skill set, and education. This does not include the value of Sturdy Health's benefits package, which includes healthcare/dental/vision and retirement benefits.

Pay

Annual salary based on full-time employment.

Schedule

Scheduled Weekly Hours: 40

Position includes a 40-hour work week with every other weekend rotation.

Qualifications

Education/Training: Graduate of an accredited school of nursing: BSN/MSN preferred

Licenses/Certifications: RN with current Massachusetts license required. CCM (Certified Case Manager) preferred. ACMA (Accredited Case Manager) preferred.

Required Qualifications: Minimum 3-5 years of experience in acute care case management, with demonstrated skills in utilization review. Demonstrated ability to use critical thinking and problem-solving skills in facilitating safe and timely patient transitions of care. Excellent communication skills and positive interpersonal dynamic in working with a variety of stakeholders across the care continuum. Solid knowledge of all insurance plan regulations including CMS/Medicaid to ensure compliance with all required processes and documentation. Strong analytical ability to interpret patient-related information, evaluate appropriateness of continued stay and/or need for ancillary services, and to reassess discharge planning needs based on daily assessment. Ability to garner and utilize information effectively to develop and modify patient plan of care. Self-starter able to function independently within the scope of position and licensure, as well as department policies and established goals. Excellent computer skills to accurately document requisite information to support patient status and medical necessity.

Preferred Qualifications: Experience in Cerner a plus. Denials management a plus.