RN Case Manager - Per Diem

About the role

Scheduled Weekly Hours: 0
Working in collaboration with the patient/family/legal representative, social workers, physicians, and interdisciplinary team, the RN case manager is accountable for assessing, coordinating and facilitating patient progression through the continuum of care in an efficient, cost effective manner.

Responsibilities

• Early assessment of pre-admission level of care, post hospital discharge needs, review of available resources
• Timely, focused communication with the healthcare team and patient/family/legal representative
• 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
• 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
• Utilize industry accepted utilization and or medical management criteria in patient status decision making
• 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

Requirements

• Minimum 3-5 years acute care case management experience, 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
• Ability to garner and utilize information effectively to develop and modify patient plan of care
• 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 successfully utilize industry accepted utilization and or medical management criteria in patient status decision making
• 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 Skills/Qualifications/Training/Experience

• Experience in Meditech and Cerner
• Denials management
• Graduate of an accredited school of nursing; BSN/MSN preferred
• RN with current Massachusetts license required
• CCM (Certified Case Manager)
• ACMA (Accredited Case Manager)

Age Specific Criteria

• Ability to effectively communicate to all age levels served within the scope of the position/assigned areas
• Ability to Meet Job Performance Expectations

Physical Demands

• Ability to sit (may be for long periods of time)
• Stand, reach and lift up to 15 pounds
• Communicate effectively with all stakeholders, in person as well as via telephone and electronically
• Interact directly with patients, with potential for direct exposure to patient care activities
• Document and use trackers, analyze charts and coordinate services within the electronic health record
• Advocate for patients both internally and external to the system
• Attend and participate professionally in meetings with Hospital leaders, physicians, patients and families

Pay

The salary range displayed on each job posting reflects the anticipated range for new hires. A successful candidate’s actual compensation will be determined after taking factors into consideration such as the candidate’s work history, experience, skill set, and education. This is not inclusive of the value Sturdy Health’s benefits package (if applicable), which includes among other benefits, healthcare/dental/vision and retirement. For annual salaries this is based on full-time employment.