RN Case Manager

Good Samaritan Medical Center; Brockton Heights (MA); On-site; USD 54,000 - 111,000; Part time

Benefits offered by this job

Health benefits

403(b) plan

Paid time off

Flexible Spending Accounts

Job summary

Good Samaritan Medical Center in Brockton, MA is seeking an experienced RN Case Manager for our BMC South location. The part-time role (32 hours; every 3rd weekend) focuses on coordinating appropriate levels of care and discharge planning with the Social Work team for medically complex patients.

You will perform InterQual reviews, collaborate with Care Coordinators, and monitor performance metrics to ensure timely discharges and compliant documentation.

Qualifications

• Must review InterQual and obtain insurance authorization.
• Collaborate with SW Care Coordinators on discharge plans.
• Monitor LOS, denials and documentation quality.

Responsibilities

• Perform InterQual reviews with insurers.
• Collaborate on discharge planning with SW.
• Coordinate clinically difficult discharges.
• Monitor department performance metrics.
• Develop educational strategies with leadership.

Skills

InterQual reviews

Discharge planning

Team collaboration

Data analytics

MS Word

Education

Nursing degree (diploma/ASN/BSN)

Tools

MS Word

MS 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

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.

• benefits (medical, dental, vision, pharmacy)
• contract increases
• Flexible Spending Accounts
• 403(b) savings matches
• earned time cash out
• paid time off
• career advancement opportunities
• resources to support employee and family wellbeing

Equal Opportunity Employer/Disabled/Veterans