Full Time Case Manager

Whittier Health Network; Westborough (MA); On-site; USD 47,000 - 67,000; 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 is seeking a Case Manager to join our full-time team. You will meet with patients and families within one day of admission to initiate discharge planning and assess needs, preferences, and barriers to recovery.

As a key member of the interdisciplinary team, you will coordinate referrals, document plans, and advocate for appropriate services and funding, ensuring smooth transitions across care levels and adherence to privacy regulations.

Qualifications

• Registered Nurse with a minimum of 5 years varied nursing experience, case management 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.

Responsibilities

• Meet with every patient/family within 1 working day of admission to introduce case management and begin an assessment of discharge needs.
• Provide patient/family information about rehabilitation process, levels of care, homecare services and patient rights.
• Attend interdisciplinary team meetings to establish a treatment plan with goals and target dates.
• Collaborate with the team for timely discharge and identify suitable facilities for continued care.
• Make referrals to next level of care and coordinate transfer and funding with payors.
• Organize referral paperwork and ensure completeness for discharge referrals.
• Maintain patient privacy and confidentiality at all times.
• Act as utilization review coordinators and monitor level of care at RTC meetings.
• Refer cases requiring medical judgment to a physician advisor.
• Maintain contact with external case managers and payors to obtain approvals for continued treatment.
• Notify team and business office of changes in exclusions or level of care.
• Attend Utilization Review Committee meetings as assigned.
• Keep patient/family informed of UR decisions and discharge options.
• Document all case management activities in the medical record.
• Participate in improvement initiatives as assigned.

Skills

Communication

Interpersonal skills

Organization

Education

Registered Nurse

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:

Benefits:

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