The RN Case Manager is responsible for assessing, coordinating, and facilitating patient progression through the continuum of care efficiently and cost-effectively by collaborating with the patient, family, physicians, and the interdisciplinary team. This involves early assessment of pre-admission needs, post-discharge requirements, resource review, and timely communication with all relevant stakeholders.
Requirements summary
A minimum of 3-5 years of acute care case management experience with demonstrated utilization review skills is required, alongside excellent critical thinking and problem-solving abilities for safe patient transitions. Candidates must possess solid knowledge of insurance regulations, including CMS/Medicaid, and strong analytical and computer skills for documentation and status decision-making.
bachelor degreeCase ManagementCommunicationDocumentationProblem SolvingComputer SkillsCritical ThinkingPlan of Care DevelopmentMedical NecessityAnalytical AbilityUtilization ReviewPatient ProgressionPatient TransitionsMedical Management CriteriaInterpersonal DynamicInsurance Plan RegulationsCMS/Medicaid Compliance
Job description
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: 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 -
Salary Range
$42.86-$66.80 -
Salary Range
Details The pay 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. - 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. Current Sturdy Health Employees – Click here to apply for open positions. Our Work Experience is the combination of everything that’s unique about our culture, our core values, our company meetings, our commitment to success, our recognition programs, but most importantly, it’s our people. Our employees are self-disciplined, hardworking, curious, trustworthy, humble and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in our area. Are you interested in a position at Sturdy Health with Dana-Farber Cancer Institute? Click here to apply!
