Nurse Case Manager

sturdymemorial; Attleboro (MA); On-site; USD 87,000 - 135,000; Full time

Benefits offered by this job

Sign on bonus eligible

Job summary

Sturdy Memorial Hospital is seeking an RN Case Manager to coordinate patient progression through the continuum of care in collaboration with patients, families, and the healthcare team. The role focuses on assessment, planning, and communication to ensure timely transitions of care.

Responsibilities include pre-admission assessments, post-discharge planning, and utilization review, with emphasis on CMS/Medicaid compliance and cost-effective care.

Qualifications

• RN graduate of an accredited school of nursing.
• ASN required; BSN/MSN preferred.
• Massachusetts RN license required.

Responsibilities

• Collaborate with patients, families, and interdisciplinary team to assess, coordinate and facilitate progression through the continuum of care.
• Perform early assessment of pre-admission level of care and post-hospital discharge needs.
• Review available resources and communicate with the healthcare team and patient/family.
• Support cost-effective and efficient discharge planning.

Skills

Utilization Review experience

Critical thinking

Communication skills

CMS/Medicaid knowledge

Problem solving

Education

Massachusetts RN license

ASN required; 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

Include but are not limited to:

• 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 Range:

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. For annual salaries this is based on full-time employment.

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.