RN Case Manager per-diem

South Shore Health; Weymouth (MA); On-site; USD 81,856 - 118,749; Part time

Job summary

A regional healthcare provider is seeking an RN Case Manager to coordinate patient care and advocate for clients. The ideal candidate will have 3-5 years of acute care experience and must be a Registered Nurse with a Bachelor's degree preferred. Responsibilities include reviewing patient records, ensuring quality outcomes, and collaborating with various healthcare teams. This role requires strong skills in negotiation, communication, and critical thinking, with flexibility to adapt to the department's varying needs.

Qualifications

• 3-5 years acute care hospital experience preferred.
• Critical Care or Emergency Department experience highly desirable.
• ACM or CCM certification within two years of hire required.

Responsibilities

• Review medical records for appropriate utilization of care.
• Assist with patient observation status to prevent discharge delays.
• Assess patient care needs and coordinate discharge plans.

Skills

Negotiation

Communication (verbal and written)

Critical thinking

Time management

Interdisciplinary collaboration

Creative problem solving

Ability to multitask in high stress environment

Education

Registered Nurse, Bachelor's prepared strongly preferred

Tools

EHR

Epic

Workday

Interqual

Job description

Overview

If you are an existing employee of South Shore Health then please apply through the internal career site.

Requisition Number: R-21196

Facility: LOC0001 - 55 Fogg Road, 55 Fogg Road, Weymouth, MA 02190

Department Name: SSH Care Progression

Status: Part time

Budgeted Hours: 0

Shift: Day (United States of America)

Under the general supervision of the Case Management Manager acts as a patient advocate/Case Manager to SSH&EC clients. An autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost efficient patient outcomes. Looks for opportunities to reduce cost while assuring the highest quality of care is maintained. Applies review criteria to determine medical necessity for admission and continued stay. Provides clinically-based case management, discharge planning and care coordination to facilitate the delivery of cost-effective quality healthcare and assists in the identification of appropriate utilization of resources across the continuum of care.

Works collaboratively with interdisciplinary staff internal and external to the Organization. Participates in quality improvement and evaluation processes related to the management of patient care.

Commits to working a minimum of 32 hours, with at least 16 hours (in 2 shifts) worked during a night and/or weekend per 4 week schedule. Also works 1 major summer or winter holiday.

Compensation Pay Range: $59.42 - $86.20

ESSENTIAL FUNCTIONS

1. The RN Case Manager is responsible for reviewing the medical record of all observation and inpatient admissions and continued stays to ensure appropriate utilization and delivery of care.
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2. Plays an essential role in assisting physicians, nursing and staff with accurate determination of a patient’s observation status. The RN Case Manager is an important resource in preventing delayed discharges of observation patients.
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3. Participates in case finding and pre-admission evaluation screening to assure reimbursement.
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4. The RN Case Manager is responsible for assessing patient acute level of care needs and works to implement and coordinate interventions aimed at facilitating a safe and timely discharge plan to the appropriate sub-acute settings in collaboration with the Case Manager Specialist.
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5. Continued.
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6. Interacts, communicates, and intervenes with multi-disciplinary healthcare team in a purposeful, goal-directed fashion. Works pro-actively and utilizes critical thinking skills to maximize the effectiveness of resource utilization. Anticipates, initiates, and facilitates problem resolution around issues of resource use and continued hospitalization, discharge planning.
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7. Establishes and maintains effective communication with all referral sources, insurers, vendors and patient supplier systems.
8. Maintains consistently a professional commitment to institutions and department’s goals and objectives. Demonstrates flexibility to the department’s needs in relation to floor and work schedule, and any other internal and external demands on the department. Continually shows commitment to the Department by extending self when need arises.
9. Maintains an updated knowledge base of and references resources outlining provider benefits for care choices, including public, private, and governmental payers and established / preferred ACO relations

11 - Is responsible for department operational excellence, regarding safe and effective discharge planning; assures department delivers quality services in accordance with applicable policies, procedures and professional standards.

1. a - Manages all activities so that quality services are provided in an efficient and effective manner.
2. b - Services provided meet all applicable regulatory requirements
3. c - Participates in departmental and organizational Quality Improvement initiatives involving the Lean principles and TIM WOODS.
4. d - Maintains departmental productivity measurements.
5. e - Has an awareness of departmental productivity measurements including LOS and utilization
6. f - Follows department policies, procedures, and standards of care that support operational excellence and productivity measurements

12 - Attains all agreed to goals and objectives within specified time frames, as part of the organization’s overall mission.

13 - Technology – Embraces technological solutions to work processes and practices.

a - eDischarge, EHR, Interqual, MCCM, Epic, Workday

Qualifications

Minimum Education - Preferred

Registered Nurse, Bachelors prepared strongly preferred

Minimum Work Experience

3-5 years acute care hospital experience preferred
Critical Care or Emergency Department experience highly desirable

Required Licenses / Registrations

RN - Registered Nurse

Required Certifications

ACM-Accredited Case Manager or CCM-Certified Case Manager within two years of hire

Required additional Knowledge, and Abilities

Demonstrated skills in the areas of: negotiation, communication (verbal and written), conflict, interdisciplinary collaboration, management, creative problem solving, and critical thinking, time management and ability to multitask in high stress environment.
Knowledge of: healthcare financing, community and organizational resources, patient care processes, and data analysis.
Knowledge of utilization management as it relates to third party payers
Knowledge of post-acute care community resources
Experience with Managed Care preferred.
Excellent verbal and written communication skills required.
Demonstrates flexibility via an ability to adapt to changing priorities and regulations.
Basic computer skills required.

Monday through Friday 8 -4:30

Weekend and Holiday rotation

Responsibilities if Required:

Education if Required:

License/Registration/Certification Requirements:

Accredited Case Manager (ACM) - National Board for Case Management (NBCM) - National Board for Case Management (NBCM), Certified Case Manager (CCM) - Commission for Case Manager Certification (CCMC) - Commission for Case Manager Certification (CCMC), RN-Registered Nurse - Board of Registration in Nursing (Massachusetts)