Site: Newton-Wellesley Hospital


At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission-from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.


At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare - people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds - to apply.



Job Summary
The RN Case Manager (CM) facilitates a discharge plan including the coordination of post acute care/services for patients admitted to Medical, Surgical, Pediatric, or Obstetrical Services, and as needed, for hospital outpatient areas including but not limited to the Emergency Department and Henderson Surgical Center. The CM may also oversee the coordination of care for both inpatient and outpatient of those patients identified as high risk for readmission. The CM will develop and implement discharge plans for those patients identified as needing post acute discharge services or post acute follow up in collaboration with the patient/legal representative, health care team/provider, insurer, and others, including community based organizations, as needed. The CM uses a collaborative process of assessment, planning, facilitation, and advocacy. She/he may use a high-risk screening criteria or other acceptable screening tools to determine what patients may benefit from specialized care coordination services. The CM consults and collaborates with physicians regarding medical necessity of admissions and appropriate level of care for hospitalized patients utilizing nationally accepted criteria. He/she routinely reviews patients' health records and communicates with the health care team/provider to ensure continued appropriate level of care, compliance with Federal and State regulations related to discharge planning, compliance with CMS regulations or other third party payers and appropriate utilization of hospital and medical resources. The CM completes timely and accurate insurance reviews as requested by third party payers. The CM will serve as a resource for physicians, hospital staff, and patients and their families in providing information about insurance coverage, limitations of coverage related to discharge planning, community resources, community referrals and post acute care options. He/she participates in quality and risk management case finding activities. The role requires the ability to offer creative, problem solving solutions using sound and prudent clinical judgment and within the scope of licensure and according to case management standards of practice. The CM seeks out educational and self-development opportunities related to care coordination, transitions of care, healthcare reimbursement, and other pertinent areas.



Qualifications


Education/Licensures/Certifications • Graduate of an accredited school of nursing. BSN preferred • Current licensure as a Registered Nurse in the Commonwealth of Massachusetts, with minimum of three years' clinical experience • Evidence of continued education and professional development. CCM or ACMA certification preferred Experience • Prior experience in the following areas: o general acute care hospital experience o healthcare reimbursement including utilization review o quality improvement o enhanced models of health care delivery • Previous acute care hospital care coordination/discharge planning required • Knowledge of the special needs and behaviors of infant, child, adolescent, adult, older adult patients preferred Skills and Abilities • Requires the ability to work independently and establish an effective relationship with physicians, office staff, and health care providers in physician's offices, community based organizations, hospitals, and other health care facilities • Requires autonomy in decision making using sound judgment based upon factual information, clinical experience, and nursing process • Requires ability to seek out and identify resources to problem solve issues • Ability to work within a multidisciplinary environment • Requires ability to be cross trained for coverage of other RN CM assignments • Requires flexibility to cover assigned shift hours as determined by departmental need • Basic computer skills including knowledge of Microsoft products and efficient data entry ability • Effective written and verbal communication skills • Excellent organizational skills



Additional Job Details (if applicable)


Additional Job Description



Remote Type


Onsite



Work Location


2014 Washington Street



Scheduled Weekly Hours


32



Employee Type


Regular



Work Shift


Day (United States of America)



EEO Statement:


Newton-Wellesley Hospital is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.




Mass General Brigham Competency Framework



At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.