RN Case Manager & Discharge Planner - Transitional Care

Whittier Health; Massachusetts; On-site; USD 95,000 - 105,000; Full time

Benefits offered by this job

401(k)

Paid time off

Dental Insurance

Medical Insurance

Vision Insurance

Health Savings Account

Flexible spending accounts

Life Insurance

Disability policies

Job summary

Whittier Rehabilitation Hospital’s Transitional Care Unit is seeking an experienced Case Manager to lead discharge planning for a 20-bed unit. The RN (preferred) will coordinate admissions to discharge, working with the care team to optimize rehabilitation services and timely planning.

The role requires strong communication and the ability to navigate CMS guidelines and managed care expectations to advocate for patients and arrange appropriate post-acute resources.

Qualifications

• Registered Nurse with 2-5 years acute case management experience in SNF.
• Excellent written and verbal communication, interpersonal and organizational skills.
• Ability to assess, analyze, plan, implement and evaluate plan of care.

Responsibilities

• To oversee and coordinate each patient's TCU stay beginning with admission through discharge.
• Work with all members of the interdisciplinary care team to identify goals, address barriers to discharge and ensure patient receives the optimum rehabilitation services in the most efficient manner.
• Provide the patient and family information about the rehabilitation process, levels of care, and patient rights/responsibilities.
• Work within the confines of CMS guidelines and/or Managed Care expectations, able to advocate for patients when possible.
• Ensure patient is provided with appropriate resources befitting next level of care setting (e.g., list of skilled nurse facilities, available home health agencies, etc.).
• Maintain appropriate patient and family contact regarding patient progress towards goals, care team discussions, as well as continual review of discharge planning efforts to ensure a safe and timely discharge plan is in place.
• Address disposition changes in timely manner, remaining proactive in anticipating patient's discharge needs.

Skills

RN license MA

Case management

Communication skills

Job description

Whittier Rehabilitation Hospital’s Transitional Care Unit is seeking an experienced Case Manager to lead discharge planning for a 20-bed unit. The RN (preferred) will coordinate admissions to discharge, working with the care team to optimize rehabilitation services and timely planning.

The role requires strong communication and the ability to navigate CMS guidelines and managed care expectations to advocate for patients and arrange appropriate post-acute resources.