Complex Discharge RN Case Manager

UMass Memorial Health; Southbridge (MA); On-site; USD 60,000 - 120,000; Full time

Job summary

Join a leading health system in Central Massachusetts as a Complex Discharge RN Case Manager. This role is crucial for ensuring efficient discharge planning while minimizing barriers and working collaboratively with a multidisciplinary team. Candidates must hold a current Massachusetts Nursing License and demonstrate experience in utilization review and discharge planning.

Qualifications

• Must possess a current Massachusetts Nursing License.
• Graduate from an accredited nursing program (RN or BSN) required.
• Experience in discharge planning and utilization review is necessary.

Responsibilities

• Responsible for discharge planning and utilization review.
• Collaborate with physicians, social workers, and healthcare team members.
• Maintain clinical documentation and adhere to ethical standards.

Skills

Case management theory and practices

Effective communication

Clinical documentation

Understanding of discharge planning rules

Knowledge of InterQual Criteria

Education

Current Massachusetts Nursing License

Graduate of an accredited school of nursing, RN or BSN

Job description

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Exemption Status

Non-Exempt

Schedule Details

Monday through Friday

Scheduled Hours

8am - 4:30 pm

Shift

1 - Day Shift, 8 Hours (United States of America)

Hours

40

Cost Center

25080 - 4402 Case Management

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

The Care Manager is a licensed health care professional who is responsible for both utilization review and discharge planning. The Care Manager collaborates with physicians, nurses, social workers, and other members of the health-care team.

The Care Manager maintains practice patterns consistent with state licensure and Joint Commission Standards.

The Care Manager adheres to professional care management ethical standards of practice.

I. Major Responsibilities

• Demonstrates a comprehensive knowledge of case management theory and practices.
• Demonstrates ability to effectively plan for patients' continuity of care needs in ambulatory care and emergency care settings.
• Clinical documentation in Medhost and Meditech
• Demonstrates understanding of the principles of Care Management
• Demonstrates accurate understanding of InterQual Criteria
• Demonstrates effective communication in a timely fashion with all involved departments concerning the appropriateness of bed status and insurance authorization
• Demonstrates effective communication with health plan case managers regarding the policies for the ECC patient.
• Demonstrates knowledge of general nursing theory and practices
• Demonstrates knowledge of discharge planning rules and regulations
• Informs director of any and all discharge planning incidents which are barriers to effective.
  
  

Standard Staffing Level Responsibilities

• Complies with established departmental policies, procedures and objectives.
• Attends variety of meetings, conferences, seminars as required or directed.
• Demonstrates use of Quality Improvement in daily operations.
• Complies with all health and safety regulations and requirements.
• Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
• Maintains, regular, reliable, and predictable attendance.
• Performs other similar and related duties as required or directed.
  
  

II. Position Qualifications

All responsibilities are essential job functions.

License/Certification/Education

Required:

• Current Massachusetts Nursing License
• Graduate of an accredited school of nursing, RN or BSN
  
  

Experience/Skills

Required:

• Experience in discharge planning and utilization review
  
  

Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.

The Complex Discharge Case Manager will facilitate discharge planning while minimizing financial losses for patients with barriers to discharge. These barriers may be due to lack of payer source for the next level of care, social determinants of health that preclude a safe and timely discharge or any other barriers or complexities that prolong hospital length of stay.

The Complex case manager will work collaboratively with the multidisciplinary team, social worker, case managers, patient financial counselors, revenue cycle, denials team, commercial payers, post-acute providers, MA Health case workers, DMH/DDS, and other agencies involved in a patients discharge planning.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at [e-mail]. We will make every effort to respond to your request for disability assistance as soon as possible.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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