Case Manager - Part Time 24-40 Hours

Whittier Health Network; Westborough (MA); On-site; USD 55,000 - 83,000; Part time

Benefits offered by this job

401(k)

Continuing education credits

Dental insurance

Disability insurance

Flexible spending account

Health insurance

Life insurance

Job summary

Whittier Rehabilitation Hospital in Westborough, MA is seeking a Part Time Case Manager to coordinate discharge planning for medically complex patients. You will meet with patients and families promptly, arrange referrals, and help navigate insurance and resources with the care team.

Responsibilities include attending team meetings, developing realistic treatment plans, and ensuring smooth transitions to the next level of care while maintaining patient privacy and compliance.

Qualifications

• Current Registered Nurse license.
• Minimum 5 years of varied nursing experience, preferably orthopedic, med-surg, geriatric or rehabilitation.
• Excellent communication, interpersonal and organizational skills.
• Ability to assess, analyze, plan, implement and evaluate.
• Knowledge of insurance eligibility, benefits and limitations.

Responsibilities

• Meet with every patient/family within 1 working day of admission to introduce case management and begin discharge planning assessment.
• Provide patient/family information about the rehabilitation process and care options in understandable terms.
• Attend interdisciplinary team meetings to set realistic goals and a discharge plan with target dates.
• Collaborate with the care team for timely discharge and coordinate next-level care arrangements.
• Make referrals, coordinate transfers, and obtain payor approvals as needed.
• Organize and review referral paperwork for discharge to ensure continuity of services.
• Maintain patient privacy and confidentiality in all interactions.
• Act as utilization review coordinator and monitor care levels per UR plan.
• Refer cases requiring medical judgment to a physician advisor.
• Maintain contact with external case managers and payors for continued stay approvals.

Skills

Excellent communication

Interpersonal skills

Organizational skills

Education

Registered Nurse license

Job description

Case Manager –Part Time

Whittier Rehabilitation Hospital is a small community hospital that does big things to help people. Our two hospital units specialize in caring for medically complex patients with a similar acuity to a medical surgical or telemetry unit. With our population typically staying for 2-3 weeks, caregivers see the same patients make progress over time.

Essential:

• Meet with every patient/family within 1 working day of admission to introduce case management and begin an assessment of potential discharge planning needs. Take into account patient’s age and developmental level, cultural and religious practices, language and emotional barriers, healthcare needs, financial situation and family/community support.
• Provide the patient and family information, in a form that they can understand, about the rehabilitation process, levels of care, homecare services, community resources and patient rights including Advance Directives.
• Attend all interdisciplinary team meetings (RTC, FTC, TTC) to collaborate with the healthcare team, patient and family to establish a treatment plan with realistic goals and a target date to achieve the goals. Identify variables that may influence the accomplishment of the goals. Continually evaluate the effectiveness of the plan and modify as needed.
• Collaborate with the healthcare team, patient and family for a timely discharge to the next level of care, when appropriate. Assist the team in identifying agencies or facilities that can meet the patient’s healthcare needs
• Make referrals to the next level of care and coordinate the transfer to maintain a continuation of services. Counsel with the patient/family and the payor to coordinate funding for the services. Obtain approval numbers from payor, if needed.
• Organize all referral paperwork needed to make discharge referral, review for completeness and fax (or have faxed) to the agency or facility that will continue to provide service.
• Maintain patient privacy and confidentiality at all times. Release only information authorized by the patient/responsible party, and only the specific information required.
• Case managers will act as utilization review coordinators.
• At each Rehab Team Conference (RTC) the patient’s level of care will be monitored, per UR plan.
• Refer any cases requiring medical judgment to a physician advisor.
• Maintain timely contact with external case managers and third party payors as required under “continued stay review” programs. Obtain approvals for continuation of the treatment plan. Advocate for services at an appropriate intensity to best meet the patient's needs.
• Notify members of the team and business office of any exclusions or level of care changes.
• Attend Utilization Review Committee meetings, as assigned.
• Keep patient and family informed of Utilization Review decisions and provide discharge planning options to meet patient care needs.
• Document all case management activities in the patient’s medical record, including notes related to conversations with patient/family, insurers and others in accordance with laws, regulations and hospital policy.
• Participate in hospital-wide or department specific performance improvement initiatives as assigned.

PREREQUISITES:

• Registered Nurse; with a minimum of 5 years varied nursing experience, preferably orthopedic, med-surg, geriatric or rehabilitation. Case management experience, preferred.
• Excellent communication (written and verbal), interpersonal and organization skills.
• Ability to assess, analyze, plan, implement and evaluate.
• Basic knowledge of insurance, including an understanding of eligibility, benefits and limitations.
• Knowledge of growth and development across the life span.

BENEFITS:Benefits:

• 401(k)
• Continuing education credits
• Dental insurance
• Disability insurance
• Flexible spending account
• Health insurance
• Life insurance