Nurse Case Manager

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 required; BSN/MSN preferred

License/Certification:

• RN with current Massachusetts license required
• CCM (Certified Case Manager) Preferred
• ACMA (Accredited Case Manager) Preferred

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: Must have the ability to perform the essential functions of the position without posing a direct threat to the health and safety of themselves or other individuals in the workplace, with or without a reasonable accommodation.

PHYSICAL DEMANDS

Include but are not limited to:

• Ability to sit (may be for long periods of time), stand, reach and lift up to 15 pounds
• Ability to readily travel to units/departments across the system.
• Ability to communicate effectively with all stakeholders, in person as well as via telephone and electronically
• 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 external to the system
• Ability to attend and participate professionally in meetings with Hospital leaders, physicians, patients and families

Sturdy Memorial Hospital is an equal employment opportunity employer. There is no discrimination because of race, color, creed, age, gender, sexual orientation, national origin, veteran status or disability.

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