RN Care Manager, 3 Surgical Step Down, 40 Hours (Days / Rotating Weekends)

bmc; Boston (MA); On-site; USD 90,000 - 120,000; Full time

Job summary

BMC in Boston is seeking an RN Care Manager to assess, plan, implement, monitor, and evaluate care for a designated patient caseload. You will identify providers and coordinate resources across the continuum to promote high-quality, cost-effective outcomes.

The role emphasizes collaboration with physicians and care teams to ensure timely discharge, comprehensive documentation, and adherence to utilization and quality standards in a busy hospital setting.

Responsibilities

• Conduct a thorough and objective evaluation of the client's current status including physical, psychosocial, environmental, financial, and health status.
• Collaborates with physicians, nursing, and multidisciplinary care team to ensure timely patient management.
• Ensures appropriate clinical pathway assignment by staff nurses.
• Addresses/resolves system problems impeding diagnostic or treatment progress.
• Proactively identifies and resolves delays and obstacles to discharge.
• Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
• Collaborates with the physician and all members of the multidisciplinary team to monitor the patient's progress and ensure that the plan of care and services provided are patient-focused, high quality, efficient, and cost effective; facilitates completion and reporting of diagnostic testing, treatment plan, discharge plan, and documentation.
• Maintains communication with medical staff to eliminate barriers to efficient delivery of care; completes utilization management and quality screening for assigned patients.
• Applies approved utilization acuity criteria to monitor admisssions and continued stays and documents findings.
• Monitors length of stay and ancillary resource use; takes actions to improve both areas.
• Assesses resource utilization and cost management; diagnoses, treatment, prognosis, goals.
• Refers cases to physician advisor and follows up as indicated.
• Communicates with resource center to facilitate covered day reimbursement certification; discusses payer criteria with clinical staff and resolves payer issues.

Job description

POSITION SUMMARY

Utilizing a collaborative process, the care manager will assess, plan, implement, monitor, and evaluate the options and services required to meet an individual's health needs, using communication and available resources to promote quality, cost-effective outcomes. The care manager helps identify appropriate providers and facilities throughout the continuum of services while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the patient and the reimbursement source. The care manager is accountable for a designated patient caseload and plans effectively in order to meet patient needs, manage the length of stay, and promote efficient utilization of resources. Specific functions within this role include: Assessment - The care manager will collect in-depth information about a person's situation and functioning to identify individual needs in order to develop a comprehensive care management plan that will address those needs. Planning - The care manager will determine specific objectives, goals, and actions as identified through the assessment process. The plan should be action oriented and time specific. Implementation - The care manager will execute specific intervention that will lead to accomplishing the goals established in the care management plan. Coordination - The care manager will organize, integrate, and modify the resources necessary to accomplish the goals established in the care management plan. Monitoring - The care manager will gather sufficient information from all relevant sources in order to determine the effectiveness of the care management plan. Evaluation - At appropriate and repeated intervals, the care manager will determine the plan's effectiveness in reaching desired outcomes and goals. This process might lead to a modification or change in the care management plan in its entirety or in any of its component parts. Position: RN Care Manager Department: 3 Surgical Step Down Schedule: 40 Hours (Days / Rotating Weekends) 10 Hour Shifts

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Conduct a thorough and objective evaluation of the client's current status including physical, psychosocial, environmental, financial, and health status expectation. As a client advocate, seek authorization for care management from the recipient of services (designee). Coordinates/facilitates patient care progression throughout the continuum.
• Works collaboratively and maintains active communication with physicians, nursing, and other members of the multidisciplinary care team to effect timely, appropriate patient management.
• Ensures appropriate clinical pathway assignment by staff nurses
• Addresses/resolves system problems impeding diagnostic or treatment progress.
• Proactively identifies and resolves delays and obstacles to discharge.
• Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
• Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.
• Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated caseload; monitors the patient's progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective; facilitates the following on a timely basis:Completion and reporting of diagnostic testingCompletion of treatment plan and discharge planModification of plan of care, as necessary, to meet the ongoing needs of the patientCommunication to 3rd party payers and other relevant information to the care teamAssignment of appropriate levels of careCompletion of all required documentation in TQ screens and patient records
• Maintain communication and collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting. Completes utilization management and quality screening for assigned patients.
• Applies approved utilization acuity criteria to monitor appropriateness of admissions and continued stays and documents findings based on department standards.
• Identifies at-risk populations using approved screening tool and follows established reporting procedures
• Monitors length of stay (LOS) and ancillary resource use on an ongoing basis. Takes actions to achieve continuous improvement in both areas.
• Assess resource utilization and cost management; the diagnosis, past and present treatment; prognosis, goals (short-and long-term).
• Refers cases and issues to physician advisor in compliance with department procedures and follows up as indicated.
• Communicates with resource center to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Uses quality screens to identi