RN Case Manager

Boston Medical Center, Corp.; Brockton (MA); Hybrid; USD 54,000 - 111,000; Part time

Job summary

Boston Medical Center is seeking an RN Case Manager for BMC South in Brockton, MA. This exempt, part-time position focuses on discharge planning for medically complex patients and collaboration with Social Work partners. The CM will rotate to assigned units and participate in orientation to Case Management Standards of Practice.

The role requires nursing licensure in MA, preference for BSN, and CM experience in acute or managed care settings. Strong data skills and teamwork are essential.

Qualifications

• Nursing degree required (diploma, ASN or BSN). BSN within 4 years required.
• MA RN licensure; Case Management certification preferred.
• Recent acute care or managed care case management experience.

Responsibilities

• Perform InterQual reviews and obtain insurance authorization.
• Collaborate with Social Worker Care Coordinators on discharge plans.
• Coordinate with SW for difficult discharge plans.
• Review department performance metrics (LOS, denials, documentation).
• Develop educational needs with Care Coordination Manager/Director.

Skills

Data analytics

Team collaboration

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Education

Nursing degree

BSN in progress/within 4 years

Tools

InterQual

Job description

Position: RN Case Manager

Location: BMC South - Brockton, MA

Schedule: Part Time, 32 hours, Every 3rd Weekend

POSITION SUMMARY:

The RN Case Manager (CM) is an exempt position and is responsible for overseeing the appropriate level of care and collaborates with the Social Work partner regarding discharge planning with a particular focus on medically complex discharge planning. The RN CM will be assigned to selected areas of the Hospital based upon department staffing and coverage. The RN CM will collaborate with SW Care Coordinator as a team to meet the needs of the patients within unit assigned. As this is an evolving position, duties and responsibilities may vary based on specific assignments. Each staff member will participate in a departmental orientation focused on Case Management Standards of Practice. All staff will be cross-trained and oriented to the ED Case Management Practice.

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Perform InterQual reviews on assigned patients and working with insurers to provide clinical information, answer questions, obtain insurance authorization for patients.

• Collaborate with Social Worker (SW) Care Coordinators on the units who will be responsible for the development and execution of patient discharge plans.

• Coordinate with the SW Care Coordinators for clinically difficult discharge plans.

• Review reports on the Department' s performance including but not limited to - LOS, clinical denials and appeal status, avoidable days, time of discharge, proper level of documentation.

• Work with Care Coordination Manager/Director to develop educational needs and identify strategies to accomplish objectives of the Department.

JOB REQUIREMENTS

• Education:Nursing degree required: diploma, ASN or BSN (preferred); Ability to obtain BSN within 4 years required

• Certifications/Licenses: MA RN licensure, Case Management certification preferred

• Experience: Recent experience in acute care setting involved with clinical activities and/or a managed care environment working in case management, recent experience in a case management role or related role

• Knowledge & Skills: Excellent computer skills including managing work against performance metrics and reporting on key indicators important to the department. Strong computer skills with knowledge and proficiency with Microsoft Word, Excel and PowerPoint. Demonstrate data analytic skills. Demonstrated skills in working collaboratively with physicians, managers and other team members. Demonstrated skills in organizing and facilitating interdisciplinary teams to ensure timely discharge. Evidence of continued professional development

Compensation Range:

$38.86- $80.77

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, and licensure/certifications directly related to position requirements. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), contract increases, Flexible Spending Accounts, 403(b) savings matches, earned time cash out, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Equal Opportunity Employer/Disabled/Veterans