RN Case Manager for Dual Eligible Special Need Plan (D-SNP)

Mass General Brigham Community Physicians; Somerville (MA); Hybrid; USD 85,000 - 115,000; Full time

Job summary

Mass General Brigham Community Physicians, Inc. is seeking an RN Case Manager to coordinate and support care within the facility and manage referrals for services outside the clinic.

You will provide outreach and enrollment assistance to meet program eligibility and work with families and service providers to develop comprehensive care plans. The role requires an RN license in Massachusetts, 2+ years in case management or discharge planning, and strong communication skills.

Qualifications

• Associate's degree in Nursing is required (Bachelor's degree preferred).
• Active and unrestricted RN licensure for Massachusetts required.
• 2+ years of case management and/or discharge planning required.
• Experience with complex dually eligible populations required.
• Knowledge of Managed Care preferred.
• Understanding of diagnostic criteria for dual conditions and placement within continuum of care preferred.
• Utilization Review experience preferred.

Responsibilities

• Conduct client assessments and planning.
• Modify patient treatment plans as indicated by patients' responses and conditions.
• Prepare patient/family for discharge.
• Communicate with third party payers to obtain authorization for reimbursement of services.
• Define care goals by providing education, information, and direction to each individual and family.
• Review cases with medical directors on challenging cases as needed.
• Maintain accurate, detailed reports and records.

Skills

Empathy

Communication

Rapport building

Confidentiality

Microsoft Office

Industry software

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing preferred

Tools

Microsoft Office

Job description

The RN Case Manager serves as a core member of the care team by coordinating and supporting healthcare within the facility and coordinating referrals for services outside the clinic. The RN provides outreach and enrollment services to meet eligibility requirements of the program and surrounding counties, and ensures coordination and planning, including community and family support, by focusing on the development and coordination of community service plans and partnering with service providers, families, and patients to create a plan of healthcare.

Primary Responsibilities

• Conduct client assessments and planning.
• Modify patient treatment plans as indicated by patients' responses and conditions.
• Prepare patient/family for discharge.
• Communicate with third party payers to obtain necessary authorization for reimbursement of services.
• Define care goals of patients by providing education, information, and direction to each individual and family.
• Review cases with medical directors on challenging cases as needed.
• Maintain accurate, detailed reports and records.

What You'll Bring

Qualifications

• Associate's Degree Nursing required (Bachelor's Degree Nursing preferred).
• Active and unrestricted Registered Nurse (RN) Licensure for the state of Massachusetts required.
• 2+ years of case management and/or discharge planning required.
• Experience working with complex dually eligible populations required.
• Knowledge of Managed Care preferred.
• Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care preferred.
• Utilization Review experience preferred.

Additional Skills and Abilities

• Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
• Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
• Ability to establish strong rapport and relationships with patients and staff.
• Proficient in Microsoft Office and industry related software programs.
• Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
• Ability to maintain client and staff confidentiality.

Schedule and Working Model

• Full-time, Monday through Friday, approximately 8:30am-5pm.
• Hybrid: Approximately 2 days per week in the field and 3 days per week at home, with flexibility as needed.

Mass General Brigham Community Physicians, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.