Case Manager - Registered Nurse

STI; United (PA); On-site; USD 75,000 - 95,000; Full time

Job summary

Beth Israel Lahey Health is seeking a Case Manager - Registered Nurse in Cambridge, MA. The role focuses on utilization review, discharge planning, and determining appropriate levels of care in collaboration with the medical team.

Requires MA RN license, 3 years medical/surgical nursing, and 2 years case management experience. Includes weekend/holiday rotation and MACIPA guidelines adherence.

Qualifications

• Bachelor's degree preferred and RN license.
• 3 years medical/surgical nursing care experience; 2 years case management/utilization management experience required.
• Basic computer and typing skills.
• Effective verbal communication skills and problem solving and conflict resolution skills.
• Ability to organize and work independently.

Responsibilities

• Performs utilization review and discharge planning for inpatient admissions to MAH.
• Applies InterQual Inpatient criteria to determine appropriateness for inpatient/outpatient care.
• Communicates with attending and house staff when inpatient options are identified.
• Leads the healthcare team in selecting appropriate, safe hospital or alternative care options.
• Coordinates and facilitates patient discharge with MAH nursing and social work staff.
• Identifies days not meeting acute hospital level of care criteria and reports to physician reviewer.
• Works with patients and families to plan post-hospital care and long-term needs.

Skills

Verbal communication

Problem solving

Independent worker

Education

RN license

Bachelor's degree preferred

Job description

Case Manager - Registered Nurse

Cambridge, MA/Local candidates not accepted***

6 months

Shift: 40 hours per week

Usually M-F 8-4:30

Occasional weekend may be required

Epic Experience Preferred

COVID Vaccines + Booster required at time of submission (declinations not accepted).

BILH cover sheet required---

Active MA license required at time of submissions

Cannot have worked perm/travel for any Beth Israel facility within the past 6 months.

Primary Responsibilities

• Performs utilization review and discharge planning to inpatient admissions to MAH.
• Applies InterQual Inpatient criteria approved by the MACIPA (risk) and MAH (non-risk) Utilization Management Committees to accurately determine appropriateness for inpatient and outpatient care.
• Communicates with attending and house staff when options to inpatient care are identified.
• Utilizes clinical expertise to determine the appropriate level of care for patients. Leads the healthcare team in selecting appropriate, safe, hospital or alternative care options.
• Works with MAH nursing and social work staff to coordinate and facilitate patient discharge.
• Identifies days not meeting acute hospital level of care criteria and reports them to the physician reviewer.
• Works with patients and families to facilitate post hospital care and develop plans to meet short and long-term needs.
• Accurately manages observation status patients by working with physicians to ensure appropriate utilization.
• Is part of the department's Saturday, holiday and beeper rotation as needed.
• Adheres to all insurance, contractual, and regulatory requirements as mandated.
• Abides by MACIPA Case Management standards as per the MACIPA CM guidelines.

Required Qualifications

• Bachelor's degree preferred. Current state license as a Registered Nurse
• Three years of medical/surgical nursing care experience. Two years of case management or utilization management experience required.
• Basic computer and typing skills.
• Effective verbal communication skills and problem solving and conflict resolution skills.
• Demonstrated ability to organize and work independently.