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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.
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:
ogeneral acute care hospital experience
ohealthcare reimbursement including utilization review
oquality improvement
oenhanced 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
EEO StatementMass General Brigham 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.
Full Time
Business Services
$96k-116k (estimate)
03/30/2024
05/30/2024
nwh.org
BURNSVILLE, MN
1,000 - 3,000
1880
NGO/NPO/NFP/Organization/Association
NORMAN HARRINGTON JR
$200M - $500M
Business Services
Newton-Wellesley Hospitalis a non-profit organization that provides general and specialty care services.
The job skills required for RN Case Manager (Regular) include Case Management, Coordination, Health Care, Planning, Problem Solving, Acute Care, etc. Having related job skills and expertise will give you an advantage when applying to be a RN Case Manager (Regular). That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by RN Case Manager (Regular). Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for RN Case Manager (Regular) positions, which can be used as a reference in future career path planning. As a RN Case Manager (Regular), it can be promoted into senior positions as a Case Management Director that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary RN Case Manager (Regular). You can explore the career advancement for a RN Case Manager (Regular) below and select your interested title to get hiring information.
If you are interested in becoming a RN Case Manager, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a RN Case Manager for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on RN Case Manager job description and responsibilities
Case Managers act as patient advocates and make sure the needs of the patient are met effectively and efficiently.
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Case Managers generally work with patients that have chronic health conditions such as diabetes, heart disease, seizure disorders, and COPD.
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The Case Manager RN reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation s
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Prepares all required documentation of case work activities as appropriate.
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Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on RN Case Manager jobs
Before becoming an RN case manager, a nurse would be expected to earn some clinical experience.
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Graduate from an Accredited Nursing Program.
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Gain Experience Working as a Nurse.
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They should be familiar with emerging professional and technical aspects and have RN case management experience.
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Step 3: View the best colleges and universities for RN Case Manager.