Full-Time
Case Manager
Whittier Health Network
Rehabilitation hospitals and skilled nursing
Compensation Overview
$33.87 - $48.91/hr
Westborough, MA, USA
In Person
Category
 Medical, Clinical & Veterinary (1) |
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Required Skills
Nursing
Requirements
- Registered Nurse status with a minimum of 5 years of varied nursing experience.
- Excellent written and verbal communication, interpersonal, and organizational skills.
- Ability to assess, analyze, plan, implement, and evaluate.
- Basic knowledge of insurance, including eligibility, benefits, and limitations.
- Knowledge of growth and development across the life span.
Responsibilities
- Meet with every patient and family within one working day of admission to introduce case management and begin assessing potential discharge planning needs, considering age and developmental level, cultural and religious practices, language and emotional barriers, healthcare needs, financial situation, and family or community support.
- Provide patients and families with understandable information about the rehabilitation process, levels of care, homecare services, community resources, and patient rights, including Advance Directives.
- Attend all interdisciplinary team meetings to collaborate with the healthcare team, patient, and family in establishing treatment plans with realistic goals and target dates; identify variables affecting goal achievement; and evaluate and modify plans as needed.
- Collaborate with the healthcare team, patient, and family to coordinate timely discharge to the next level of care and identify agencies or facilities capable of meeting the patient's healthcare needs.
- Make referrals to the next level of care and coordinate transfers to maintain continuity of services; counsel with patients, families, and payors to coordinate funding; and obtain payor approval numbers when needed.
- Organize referral paperwork, review it for completeness, and fax or arrange for it to be faxed to the agency or facility continuing the patient's services.
- Maintain patient privacy and confidentiality and release only authorized information required for the applicable purpose.
- Act as a utilization review coordinator.
- Monitor the patient's level of care at each Rehab Team Conference according to the utilization review plan.
- Refer cases requiring medical judgment to a physician advisor.
- Maintain timely contact with external case managers and third-party payors under continued-stay review programs; obtain approvals for continuation of the treatment plan; and advocate for services at an appropriate intensity.
- Notify team members and the business office of exclusions or level-of-care changes.
- Attend Utilization Review Committee meetings as assigned.
- Keep patients and families informed of utilization review decisions and provide discharge planning options that meet patient care needs.
- Document all case management activities in the patient's medical record, including conversations with patients, families, insurers, and others, in accordance with laws, regulations, and hospital policy.
- Participate in hospital-wide or department-specific performance improvement initiatives as assigned.
Desired Qualifications
- Case management experience is preferred.
- Experience in orthopedic, medical-surgical, geriatric, or rehabilitation nursing is preferred.
Whittier Health Network is a family-owned post-acute healthcare organization serving Massachusetts and New Hampshire. Its network includes rehabilitation hospitals, transitional care units and skilled nursing or long-term care facilities. Multidisciplinary teams provide complex medical management, inpatient rehabilitation, therapy, wound care and support for safe transitions home or to the next level of care. Whittier's continuum is designed for patients recovering after illness, injury or surgery, distinguishing it from an acute general hospital system or residential senior-living operator alone.
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