RN Case Manager: Discharge & Care Coordination Lead

Baystate Health; Springfield, Northern (MA, KY); Hybrid; USD 98,000 - 133,000; Full time

Benefits offered by this job

High-quality health insurance

Dental and vision insurance

Certification and continuing education

403b retirement plan

Life insurance

Wellbeing programs

Wellbeing activities reimbursement

Job summary

Baystate Health is seeking a Hospital Case Manager to coordinate clinical care, quality and financial outcomes for a defined patient population, guiding an interdisciplinary team to develop complex discharge plans and ensure safe transitions.

The role requires strong nursing expertise, with BSN preferred and 3–5 years of clinical experience, emphasis on care coordination, utilization review, and collaboration with payers to optimize outcomes.

Qualifications

• BSN preferred
• 3-5 years clinical nursing experience
• Hospital case management and care coordination experience preferred

Responsibilities

• Facilitates patients care plan as called for in the plan of care
• Leads daily patient care huddles with nursing to direct timely progress along the continuum
• Works cooperatively as a leading member of the health care team to insure appropriate use of hospital resources, patient satisfaction, and achievement of quality of care
• Evaluates and ensures appropriateness of admissions and continued stay using evidence-based criteria
• Collaborates and manages outcomes with the payers through ongoing written and verbal communications to appropriate parties
• Leads discussions with Physician advisors and MD's about safe plan for transitions
• Leads the team to ensure appropriate utilization of patient resources and directs care to other settings when appropriate
• Collaborates with community case managers and other health care advisors to ensure a smooth and safe continuum of care plan
• Conducts extensive assessments and implements interventions for patients at risk for readmissions
• Manages concurrent denials and works with physicians to overturn for appropriate reimbursement

Skills

Community resources

Utilization review

Prioritization

Interpersonal skills

Weekend availability

Education

Associates Degree in Nursing (Required)

Bachelors Degree in Nursing

Case Management Certification

RN – Massachusetts

Job description

Baystate Health is seeking a Hospital Case Manager to coordinate clinical care, quality and financial outcomes for a defined patient population, guiding an interdisciplinary team to develop complex discharge plans and ensure safe transitions.

The role requires strong nursing expertise, with BSN preferred and 3–5 years of clinical experience, emphasis on care coordination, utilization review, and collaboration with payers to optimize outcomes.