RN Case Manager - Primary Care - Boston

Job Profile Summary

This role focuses on providing professional and nonprofessional nursing care services in accordance with physician orders. It also involves performing Care Manager related duties such as coordinating patient care, improving outcomes, and creating efficiencies.

Job Overview

The RN Case Manager manages a designated caseload to coordinate and complete timely assessment, planning, implementation, and evaluation of discharge plans and care transitions across the continuum of care.

Minimum Qualifications

• Massachusetts RN Licensure
• 3 Years of RN Experience
• Current Basic Life Support (BLS) Certification

Preferred Qualifications

• Bachelor of Science in Nursing (BSN)

Duties and Responsibilities

The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.

• Interviews and collects specific information and data from patients and families, contributing to the identification of specific physical, emotional, educational, and cultural needs of those patients.
• Maintains documentation of assessment findings, discharge arrangements, and actions taken according to departmental guidelines.
• Completes a discharge assessment, to include appropriate documentation, according to established policies and procedures.
• Identifies barriers to efficient cost-effective provision of care.
• Identifies expected outcomes individualized to the patient.
• Collaborates with physician, healthcare team, and the patient/family in decision making and planning of care during hospitalization and in anticipation of discharge.
• Implements the plan of care to achieve the identified expected outcomes for the patient.
• Utilizes community and other resources and systems to implement the plan facilitating referrals when appropriate.
• Provides education for the patients and families and documents according to policy.
• Coordinates activities related to financial/insurance issues, including providing clinical updates to insurance companies.
• Coordinates insurance appeals related to discharges and adheres to policies and procedures of Medicare and Medicaid.
• Aids in achieving unit quality scores which meet or exceed hospital established targets for nurse sensitive quality indicators as appropriate for the unit.

Physical Requirements

• Ability to sit for extended periods of time.
• Prolonged standing and walking.
• Occasional twisting, bending, reaching, pushing/pulling, sitting, kneeling, and squatting.

Skills & Abilities

• Ability to plan, implement and evaluate data and individual patient needs after emergency department visits.
• Ability to effectively communicate with patients, families, physicians, and healthcare team.
• Ability to analyze, evaluate multiple solutions, and solve complex problems using well developed critical & analytical thinking skills.
• Knowledge of and application of the nursing process.
• Excellent time management skills needed to prioritize competing priorities.
• Requires the ability to work independently and establish an effective working relationship with healthcare providers in physician’s offices, community agencies, hospitals, and other healthcare facilities.
• Maintains working knowledge of specific benefits and reimbursement guidelines, the discharge planning process, and applicable federal, state, and local regulations.