RN Case Manager

Boston Medical Center (BMC); Brockton (MA); On-site; USD 54,000 - 111,000; Part time

Benefits offered by this job

Medical, dental, vision

403(b) matches

Paid time off

Job summary

Boston Medical Center (BMC) in Brockton, MA is seeking a part-time RN Case Manager to oversee appropriate levels of care and work with Social Work on complex discharge planning for medically complex patients.

The role involves InterQual reviews, insurer communication, and collaboration with SW Care Coordinators to ensure timely, efficient discharges and continued team education to meet department goals.

Qualifications

• Nursing degree required (diploma, ASN or BSN).
• MA RN licensure; Case Management certification preferred.
• Experience in acute care or managed care case management.
• Proficient with Word, Excel and PowerPoint; data analytics skills.

Responsibilities

• Perform InterQual reviews and obtain insurer authorizations.
• Collaborate with Social Work Care Coordinators on discharge plans.
• Coordinate with care teams for difficult discharge plans.
• Review department performance metrics (LOS, denials, documentation).
• Support education and cross-training within the team.

Skills

InterQual reviews

Insurance coordination

Data analytics

Team collaboration

Discharge planning

Education

Nursing degree (diploma/ASN/BSN)

BSN within 4 years

Tools

MS Word

Excel

PowerPoint

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

Scope of Authority:

• 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

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