Full Time Case Manager

Whittier Health Network; Westborough (MA); On-site; USD 24,322,000 - 35,231,000; Full 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 Westborough in Westborough, MA seeks a full-time Case Manager to begin discharge planning within one working day of admission and coordinate patient care needs.

You will collaborate with the interdisciplinary team to develop goals, assess eligibility, arrange referrals, and advocate for services while protecting patient privacy. This role requires strong communication and organization.

Qualifications

• Registered Nurse with a minimum of 5 years varied nursing experience.
• Case management experience preferred.
• Excellent communication and organization skills.
• Ability to assess, plan, implement and evaluate.
• Basic knowledge of insurance, including eligibility, benefits and limitations.

Responsibilities

• Meet with patient/family within 1 working day of admission to introduce case management and begin an assessment of discharge planning needs.
• Provide information about rehabilitation, levels of care, homecare services, and patient rights.
• Attend interdisciplinary team meetings to develop a treatment plan with goals and target dates.
• Collaborate to ensure timely discharge and appropriate referrals to next level of care.
• Make referrals and coordinate transfers; obtain payor approvals as needed.
• Organize referral paperwork and maintain patient privacy.
• Serve as utilization review coordinator and monitor care level changes.
• Document case management activities in the medical record.
• Participate in performance improvement initiatives.

Skills

Case management

Communication

Organization

Nursing

Education

Registered Nurse (RN)

Job description

Whittier Rehabilitation Hospital Westborough
150 Flanders Road
Westborough, MA 01510
Case Manager -Full Time
Pay: $33.87-$48.91
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:

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