RN Case Manager

Come join our Case Management team! South Shore Health has a highly comprehensive and patient-centered approach to care progression. Coordinated and collaborative efforts, especially involving the specialized roles of case managers, can make a significant difference in achieving optimal health outcomes for patients. By focusing on continuous care, management of chronic diseases, and ensuring access to appropriate resources, they truly prioritize the well-being and individualized needs of the patient.

The Case Manager is an autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost-efficient patient outcomes. Looks for opportunities to reduce cost while assuring the highest quality of care is maintained.

Applies review criteria to determine medical necessity for admission and continued stay. Provides clinically based case management, discharge planning and care coordination to facilitate the delivery of cost-effective quality healthcare and assists in the identification of appropriate utilization of resources across the continuum of care.

Works collaboratively with interdisciplinary staff internal and external to the Organization. Participates in quality improvement and evaluation processes related to the management of patient care.

• The RN Case Manager is responsible for reviewing the medical record of all observation and inpatient admissions and continued stays to ensure appropriate utilization and delivery of care.
• Plays an essential role in assisting physicians, nursing and staff with accurate determination of a patient’s observation status. The RN Case Manager is an important resource in preventing delayed discharges of observation patients.
• Participates in case finding and pre-admission evaluation screening to assure reimbursement.
• The RN Case Manager is responsible for assessing patient acute level of care needs and works to implement and coordinate interventions aimed at facilitating a safe and timely discharge plan to the appropriate sub-acute settings in collaboration with the Case Manager Specialist.
• Ensure that patient has received all information related to choice of follow-up care facilities according to patient and family preference and any ACO preferred contracted providers.
• Interacts, communicates, and intervenes with multi-disciplinary healthcare team in a purposeful, goal-directed fashion. Works pro-actively and utilizes critical thinking skills to maximize the effectiveness of resource utilization. Anticipates, initiates, and facilitates problem resolution around issues of resource use and continued hospitalization, discharge planning.
• Establishes and maintains effective communication with all referral sources, insurers, vendors and patient supplier systems.
• Maintains consistently a professional commitment to institutions and department’s goals and objectives. Demonstrates flexibility to the department’s needs in relation to floor and work schedule, and any other internal and external demands on the department. Continually shows commitment to the Department by extending self when need arises.
• Maintains an updated knowledge base of and references resources outlining provider benefits for care choices, including public, private, and governmental payers and established / preferred ACO relations
• Is responsible for department operational excellence, regarding safe and effective discharge planning; assures department delivers quality services in accordance with applicable policies, procedures and professional standards.
• Attains all agreed to goals and objectives within specified time frames, as part of the organization’s overall mission.
• Embraces technological solutions to work processes and practices. eDischarge, EHR, Interqual, MCCM, Epic, Workday

Job Requirements:

Minimum Education - Preferred

Registered Nurse, bachelor's degree prepared strongly preferred

Minimum Work Experience

• 3-5 years acute care hospital experience preferred
• Critical Care or Emergency Department experience highly desirable

Required Licenses / Registrations

• RN - Registered Nurse

Required Certifications

• ACM - Accredited Case Manager or CCM - Certified Case Manager within two years of hire.

Knowledge, Skills and Abilities:

• Demonstrated skills in the areas of negotiation, communication (verbal and written), conflict, interdisciplinary collaboration, management, creative problem solving, and critical thinking, time management and ability to multitask in high stress environment.
• Knowledge of healthcare financing, community and organizational resources, patient care processes, and data analysis.
• Utilization management as it relates to third party payers
• Post-acute care community resources
• Experience with Managed Care preferred.
• Excellent verbal and written communication skills required.
• Demonstrates flexibility via an ability to adapt to changing priorities and regulations.

Work Schedule: Monday - Friday 8:00am - 4:30pm w/ weekend and holiday requirements