RN, Case Manager, Per Diem

Umass-Memorial-Health-; Southbridge (MA); On-site; USD 58,000 - 103,000; Full time

Benefits offered by this job

Signing bonus potential

Job summary

UMass Memorial Health is seeking a Care Manager to handle utilization review and discharge planning. You will collaborate with physicians, nurses and social workers to ensure smooth patient transitions and adherence to standards, including InterQual criteria.

The role requires a Massachusetts nursing license, nursing degree, and demonstrated discharge planning experience within a hospital setting. This position may offer a signing bonus; strong communication and organization are essential.

Qualifications

• Licensed nurse with MA license and active practice.
• Experience in discharge planning and utilization review required.
• Familiarity with InterQual criteria and care coordination processes.

Responsibilities

• Plan for patients' continuity of care across ambulatory and emergency settings.
• Perform clinical documentation in Medhost and Meditech.
• Collaborate with physicians, nurses, social workers and care team.
• Monitor bed status and insurance authorization with health plans.
• Ensure discharge planning aligns with standards and regulations.

Skills

Discharge planning experience

Utilization review

InterQual Criteria understanding

Effective cross-departmental коммуника

Clinical nursing knowledge

Education

Current Massachusetts Nursing License

RN or BSN graduate

Tools

Medhost

Meditech

Job description

Are you an internal caregiver, student, or contingent worker/agency worker at UMass Memorial Health? CLICK HERE to apply through your Workday account.Exemption Status:Non-ExemptHiring Range:$41.81 - $75.25Please note that the final offer may vary within this range based on a candidate’s experience, skills, qualifications, and internal equity considerations .Schedule Details:Monday through Friday, Weekends (Saturday and Sunday)Scheduled Hours:8a-430pShift:1 - Day Shift, 8 Hours (United States of America)Hours:0Cost Center:25080 - 4402 Case ManagementThis position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.Everyone Is a CaregiverAt UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.The Care Manager is a licensed health care professional who is responsible for both utilization review and discharge planning. The Care Manager collaborates with physicians, nurses, social workers, and other members of the health-care team.The Care Manager maintains practice patterns consistent with state licensure and Joint Commission Standards.The Care Manager adheres to professional care management ethical standards of practice.Job DescriptionI. Major Responsibilities:1. Demonstrates a comprehensive knowledge of case management theory and practices.2. Demonstrates ability to effectively plan for patients' continuity of care needs in ambulatory care and emergency care settings.3. Clinical documentation in Medhost and Meditech4. Demonstrates understanding of the principles of Care Management5. Demonstrates accurate understanding of InterQual Criteria6. Demonstrates effective communication in a timely fashion with all involved departments concerning the appropriateness of bed status and insurance authorization7. Demonstrates effective communication with health plan case managers regarding the policies for the ECC patient.8. Demonstrates knowledge of general nursing theory and practices9. Demonstrates knowledge of discharge planning rules and regulations10. Informs director of any and all discharge planning incidents which are barriers to effective.Standard Staffing Level Responsibilities:1. Complies with established departmental policies, procedures and objectives.2. Attends variety of meetings, conferences, seminars as required or directed.3. Demonstrates use of Quality Improvement in daily operations.4. Complies with all health and safety regulations and requirements.5. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.6. Maintains, regular, reliable, and predictable attendance.7. Performs other similar and related duties as required or directed.All responsibilities are essential job functions.II. Position Qualifications:License/Certification/Education:Required:1. Current Massachusetts Nursing License2. Graduate of an accredited school of nursing, RN or BSNExperience/Skills:Required:1. Experience in discharge planning and utilization reviewUnless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.III. Physical Demands and Environmental Conditions:1. Moderate physical activity required including but not limited to walking. Must demonstrate emotional stability. May be required to work additional hours. Must demonstrate flexibility in relating to individuals of varying disabilities, and from different cultures, socio-economic and spiritual backgrounds2. This job requires that weight be lifted, or force be exerted.3. Good Physical Environment. May have to travel outside the hospital to attend workshops and conferencesAll qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at [e-mail]. We will make every effort to respond to your request for disability assistance as soon as possible.