Nurse Case Manager

Sturdy Memorial Hospital; Attleboro (MA); On-site; USD 87,000 - 135,000; Part time

Benefits offered by this job

Sign-on bonus eligible

Job summary

Sturdy Memorial Hospital in Attleboro, MA is seeking an RN Case Manager to coordinate patient progression through the continuum of care. The role focuses on utilization review, discharge planning, and effective communication with families, physicians, and the care team.

Requirements include 3–5 years of acute care case management, Massachusetts RN license, and CCM/ACMA preferred. Sign-on bonus eligible; ability to work with diverse stakeholders and documentation in EHRs is essential.

Qualifications

• Minimum 3-5 years acute care case management experience, with demonstrated skills in utilization review.
• Demonstrated ability to use critical thinking and problem solving skills in facilitating safe and timely patient transitions of care.
• Excellent communication skills and positive interpersonal dynamic in working with a variety of stakeholders across the care continuum.
• Solid knowledge of all insurance plan regulations including CMS/Medicaid to ensure compliance with all required processes and documentation.
• Ability to garner and utilize information effectively to develop and modify patient plan of care.
• Strong analytical ability to interpret patient-related information, evaluate appropriateness of continued stay and/or need for ancillary services, and to reassess discharge planning needs based on daily assessment.
• Ability to successfully utilize industry accepted utilization and or medical management criteria in patient status decision making.
• Self-starter able to function independently within the scope of position and licensure, as well as department policies and established goals.
• Excellent computer skills to accurately document requisite information to support patient status and medical necessity

Responsibilities

• Collaborate with patient/family/legal representative, social workers, physicians and interdisciplinary team to assess and coordinate care.
• Assess pre-admission level of care and post-discharge needs to facilitate safe transitions.
• Review available resources and communicate with the healthcare team to support patient status decisions.
• Document and track patient status and medical necessity in the electronic health record.
• Advocate for patient needs and participate in meetings with hospital leaders and clinicians.

Skills

Utilization review

Critical thinking

Communication skills

CMS/Medicaid knowledge

Discharge planning

Data/documentation

Electronic health record

Independent work

Analytical ability

Problem solving

Education

RN license Massachusetts

ASN

BSN/MSN preferred

Tools

Meditech

Cerner

Denials management

Job description

Scheduled Weekly Hours: 24 - Every weekend 8-4:30 with floating day during the week. Sign on bonus eligible. Utilization Review experience required.

Working in collaboration with the patient/family/legal representative, social workers, physicians, and interdisciplinary team, the RN case manager is accountable for assessing, coordinating and facilitating patient progression through the continuum of care in an efficient, cost effective manner. The RN Case Manager must achieve this through early assessment of pre-admission level of care, post hospital discharge needs, review of available resource and timely, focused communication with the healthcare team and patient/family/legal representative.

Required Skills/Qualifications/Training/Experience:

• Minimum 3-5 years acute care case management experience, with demonstrated skills in utilization review
• Demonstrated ability to use critical thinking and problem solving skills in facilitating safe and timely patient transitions of care
• Excellent communication skills and positive interpersonal dynamic in working with a variety of stakeholders across the care continuum
• Solid knowledge of all insurance plan regulations including CMS/Medicaid to ensure compliance with all required processes and documentation
• Ability to garner and utilize information effectively to develop and modify patient plan of care
• Strong analytical ability to interpret patient-related information, evaluate appropriateness of continued stay and/or need for ancillary services, and to reassess discharge planning needs based on daily assessment
• Ability to successfully utilize industry accepted utilization and or medical management criteria in patient status decision making
• Self-starter able to function independently within the scope of position and licensure, as well as department policies and established goals
• Excellent computer skills to accurately document requisite information to support patient status and medical necessity

Preferred Skills/Qualifications/Training/Experience:

• Experience in Meditech and Cerner a plus
• Denials management a plus

Educational Requirements:

RN Graduate of an accredited school of nursing required ASN required; BSN/MSN preferred

License/Certification:

• RN with current Massachusetts license required
• CCM (Certified Case Manager) Preferred
• ACMA (Accredited Case Manager) Preferred

Age Specific Criteria:

Ability to effectively communicate to all age levels served within the scope of the position/assigned areas.

Ability to Meet Job Performance Expectations:

Must have the ability to perform the essential functions of the position without posing a direct threat to the health and safety of themselves or other individuals in the workplace, with or without a reasonable accommodation.

PHYSICAL DEMANDS

• Ability to sit (may be for long periods of time), stand, reach and lift up to 15 pounds
• Ability to readily travel to units/departments across the system.
• Ability to communicate effectively with all stakeholders, in person as well as via telephone and electronically
• Ability to interact directly with patients, with potential for direct exposure to patient care activities
• Ability to document and use trackers, analyze charts and coordinate services within the electronic health record
• Ability to advocate for patients both internally and external to the system
• Ability to attend and participate professionally in meetings with Hospital leaders, physicians, patients and families

Salary

Salary Range: $87,015.12-$135,323.52 - Salary Range Details The pay range displayed on each job posting reflects the anticipated range for new hires. A successful candidate’s actual compensation will be determined after taking factors into consideration such as the candidate’s work history, experience, skill set, and education. This is not inclusive of the value Sturdy Health’s benefits package (if applicable), which includes among other benefits, healthcare/dental/vision and retirement.

Benefits

• healthcare/dental/vision
• retirement

EEO Statement

Sturdy Memorial Hospital is an equal employment opportunity employer. There is no discrimination because of race, color, creed, age, gender, sexual orientation, national origin, veteran status or disability.

Company Culture

Our Work Experience is the combination of everything that’s unique about our culture, our core values, our company meetings, our commitment to success, our recognition programs, but most importantly, it’s our people. Our employees are self-disciplined, hardworking, curious, trustworthy, humble and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in our area.