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Mass General Brigham

Early-stage life science venture investor

RN Care Coordinator - Case Manager

Medical, Clinical & VeterinaryPosted on Nov 13
Full-timeBoston, MA, USAIn-person

About the Job

Requirements

  • Graduate of an approved school of nursing and hold current registration in Massachusetts.
  • Newly licensed nurses must have a Bachelor of Science degree in Nursing.
  • Have at least five years of acute care experience.
  • Have previous experience in a hospital or health care setting.
  • Demonstrate strong clinical assessment skills.
  • Have strong organizational skills and the ability to set priorities.
  • Be able to compile data from concurrent and retrospective medical record review to determine clinical appropriateness.
  • Be able to meet patient needs based on clinical diagnosis, level of care, and discharge plan.
  • Be able to negotiate several aspects of care coordination simultaneously.
  • Have excellent written and verbal communication skills.
  • Be flexible and able to work well independently.

Responsibilities

  • Manage a caseload of patients and ensure care supports desired clinical and financial outcomes.
  • Coordinate care prescribed by an interdisciplinary team using patient assessment, care guidelines, protocols, payer regulations, and response to therapies to assess the episode of illness from pre-admission through post-discharge.
  • Participate in ongoing evaluation of practice patterns and systems and support efforts to improve quality, cost, and satisfaction outcomes.
  • Mobilize resources to maximize the efficiency of care delivery.
  • Coordinate and ensure implementation of the plan of care using case management principles.
  • Develop a provisional treatment program and tentative discharge date prior to or within 24–48 hours of admission by interviewing the patient or family and discussing with the physician team, attending physician, and other team members.
  • Review the daily treatment plan with physicians, nurses, and patients or families to ensure interdisciplinary communication and coordination.
  • Participate in patient care rounds with nursing staff and physicians to contribute to the plan of care and monitor and report patient progress.
  • Collaborate with other departments to expedite sequencing and scheduling of interventions, consultations, treatments, and ancillary services.
  • Provide daily continuity with patients to ensure discharge-related needs are met.
  • Incorporate utilization management principles and payer contracts into patient plans of care and keep physicians and nurses informed of implications.
  • Present alternatives to inpatient stay to the attending physician, team, and patient or family based on assessed patient level of care and insurance benefits.
  • Seek assistance or consultation from Care Coordination leadership for plans involving outlier and potential or actual resource-intensive patients.
  • Interact with internal and external health care providers to facilitate patient care, including post-discharge services.
  • Contribute to the development, implementation, and monitoring of practice guidelines.
  • Identify attending, resident, and nurse learning needs related to case management and work with service leaders to develop an educational plan.
  • Coordinate and execute discharge planning, ensuring each patient has a discharge plan.
  • Assess continuing care needs in conjunction with other caregivers.
  • Coordinate and schedule interdisciplinary meetings with the patient and family regarding discharge needs and plans as appropriate.
  • Ensure patient education consistent with the discharge plan has occurred.
  • Identify service, treatment, and funding options for post-hospital care.
  • Promote interdisciplinary patient and family communication and documentation that facilitate discharge planning, striving to finalize plans the day prior to discharge.
  • Perform patient and family follow-up after discharge to monitor and support desired outcomes.
  • Initiate contact with home health agencies and extended care facilities to ensure prompt and effective transitions of care.
  • Collaborate with appropriate individuals, departments, and payers to ensure appropriateness of admission, continued days of stay, and reimbursement.
  • Identify patients likely to have unmet insurance and resource needs and communicate with or refer them to health care team members and appropriate departments.
  • Communicate with third-party payers regarding patient progress with the treatment plan as needed.
  • Identify the need for and issue Medicare notices of non-coverage, documenting the process and communications to the patient or family and other health care team members.
  • Use industry-accepted utilization or medical management criteria, including InterQual, to identify, monitor, and report variances from the established treatment plan, including appropriateness of admission, continued stay, treatment delays, and discharge plan.
  • Conduct documented utilization reviews for insurers or intermediaries.
  • Identify SNF and AND days for Medicare and Medicaid patients.
  • Initiate concurrent actions to reduce or eliminate inappropriate hospital admissions and days and system delays.
  • Work with payers and physicians to address level-of-care concerns concurrently that affect claims and reimbursement.
  • Contribute to utilization and practice improvement by reviewing reports with colleagues and providing feedback on utilization trends and payer issues.
  • Serve as the primary patient information source to third-party payers.

Desired Qualifications

  • Inpatient acute case management experience is strongly preferred.
  • Utilization management or utilization review experience is preferred.
  • Clinical documentation improvement experience is preferred.
  • Home Hospital Case Management experience is preferred.
  • Bilingual English and Spanish language skills are preferred.

About the Company

Mass General Brigham

Early-stage life science venture investor

Mass General Brigham Ventures funds early-stage life science ideas arising from Mass General Brigham’s research network. It provides first access to deal flow and proprietary rights, backing the formation and growth of new companies and technologies. It uses capital and support to help translate bold innovations into drugs and medical technologies that improve patient outcomes worldwide.

Company size
1-10
Company stage
Not listed
Total funding
$1.9B
Headquarters
Cambridge, MA
Founded
2008

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