RN Care Coordinator - Case Manager
$41.71 - $105.65/hr+ Differentials + Premiums + Bonuses
Senior
Bachelor's
Boston, MA, USA
In Person
Medical, Clinical & Veterinary
About the job
Requirements
- Graduate of an approved school of nursing with current registration in Massachusetts.
- Newly licensed nurses must have a Bachelor of Science degree in Nursing.
- At least 5 years of acute care experience is required.
- At least 1 year of inpatient acute case management experience is required.
- Bilingual English and Spanish is preferred.
- Previous experience in a hospital or health care setting is required.
- Strong clinical assessment skills are required.
- Ability to work collaboratively and cooperatively within a team and with internal and external customers is required.
- Strong organizational skills and ability to set priorities are required.
- Ability to compile data from concurrent and retrospective medical record review to determine clinical appropriateness is required.
- Ability to meet a patient’s needs based on their clinical diagnosis, level of care, and discharge plan is required.
- Ability to negotiate several aspects of care coordination simultaneously is required.
- Excellent written and verbal communication skills are required.
- Must 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 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 before or within 24–48 hours of admission through interviews with patients or families and discussions with the physician team and other team members.
- Review the daily treatment plan with physicians, nurses, and patients or families to ensure interdisciplinary communication and coordination.
- Participate with nursing staff and physicians in patient care rounds 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 needs related to discharge are met.
- Incorporate utilization management principles and payer contracts into patient plans of care and inform physicians and nurses of their 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 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 for patients, 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 communications and documentation that facilitate discharge planning, striving to finalize plans the day before 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 transition of care.
- Collaborate with appropriate individuals, departments, and payers to ensure the appropriateness of admission, continued 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 other 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 communicating with patients or families and other members of the health care team.
- 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 planning.
- 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 efforts by reviewing reports with colleagues and providing feedback on utilization trends and payer issues.
- Serve as the primary patient information source for third-party payers.
Desired Qualifications
- Bilingual English and Spanish is preferred.
About the company
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
N/A
Total Funding
$1.9B
Headquarters
Cambridge, Massachusetts
Founded
2008
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Simplify's Take
What believers are saying
- Mass General Brigham reported $15 million operating income through June 30, 2026.
- Outpatient growth and higher-acuity inpatient volumes drove 7% revenue growth in Q3 FY26.
- Abcuro's 2026 financing extends a potential registrational trial, validating MGB Ventures sourcing.
What critics are saying
- Brigham nurses authorized an indefinite strike on September 24, 2026; operations face disruption.
- MGB refused negotiations after July strikes and lockouts, deepening staffing instability into 2027.
- The September 2026 antidiscrimination case and website-data settlement reinforce litigation overhangs.
What makes Mass General Brigham unique
- Mass General Brigham controls flagship Boston hospitals and a research-to-venture pipeline.
- MGB Ventures backed Abcuro's $66 million Series D in August 2026.
- Its $22.8 billion 2025 operating revenue funds clinical, academic, and commercialization depth.
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Benefits
- Health Insurance
- Dental Insurance
- Vision Insurance
- 401(k) Retirement Plan
- Flexible Work Hours
- Remote Work Options
- Hybrid Work Options
- Paid Vacation
- Paid Sick Leave
- Paid Holidays
- Family Planning Benefits
- Fertility Treatment Support