RN Case Manager

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. The RN Case Manager must achieve this through early assessment of pre-admission level of care, post hospital discharge needs, review of available resource and timely, focused communication with the healthcare team and patient/family/legal representative.

Required Skills/Qualifications/Training/Experience:

• 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 a plus
• Denials management a plus

Educational Requirements:

• RN Graduate of an accredited school of nursing; BSN/MSN preferred

License/Certification:

• RN with current Massachusetts license required

• CCM (Certified Case Manager) Preferred

• ACMA (Accredited Case Manager) Preferred

Age Specific Criteria: