Clinical Case Manager – Care Transitions & Utilization

Berkshire Health Systems; North Adams (MA); On-site; USD 85,000 - 105,000; Full time

Job summary

Berkshire Medical Center is seeking a Case Manager to oversee admission, discharge planning and transition care, coordinating services across the continuum for optimal outcomes and cost containment.

The role requires robust clinical experience in acute care and familiarity with utilization management, CMS regulations, and evidence-based criteria tools. Strong communication and data-analysis skills are essential to support quality patient care.

Qualifications

• Three years clinical experience in acute care in areas such as internal medicine, surgery, orthopedics.
• Three years clinical experience in Rehab Setting, Home Health and Long-Term Care would be considered.
• Ability to perform a comprehensive admission and discharge risk assessment related to quality, financial, payer benefit allowances and limitations, risk management and patient satisfaction.
• Case Management experience required for weekend, temporary and per diem positions.
• Current knowledge of CMS (levels of care determinations), appeal rights & DPH regulations required.
• Current knowledge of Ma Pro QIO (appeals) required

Responsibilities

• Manage admission and discharge planning and transition care for patients.
• Coordinate and monitor services across the continuum of care.
• Collaborate with multidisciplinary team to ensure appropriate level of care and resource utilization.
• Review patient care and negotiate with providers, patients, and payers as needed.

Skills

Case management experience

Utilization management

CMS level of care knowledge

Discharge planning

Regulatory knowledge

Data analysis

Education

Associate degree in Nursing

Bachelor's degree in Nursing

Job description

Berkshire Medical Center is seeking a Case Manager to oversee admission, discharge planning and transition care, coordinating services across the continuum for optimal outcomes and cost containment.

The role requires robust clinical experience in acute care and familiarity with utilization management, CMS regulations, and evidence-based criteria tools. Strong communication and data-analysis skills are essential to support quality patient care.