Nurse Manager Case Management

Winchester Hospital Burlington , MA 01803

Posted 7 months ago

Welcome To

Lahey Health is a vibrant and growing health care system, recognized as a trailblazer in medicine and a standard bearer in patient experience. It includes an award-winning academic medical center, a superb constellation of community hospitals, home care services, rehabilitation facilities and more.

We are committed to attracting, developing and retaining top talent in a market long recognized and revered as a global leader in health. With a team approach to care, we encourage learning and growth at all levels, and we offer competitive salaries and benefits. We adhere to the principles of a just and fair work environment for all colleagues, where respect is foundational and performance is rewarded.

About the Job
1.Creates data priorities and report formats that display critical outcome factors, inclusive of LOS, payer data , referral patterns
2.Provides feedback to the department staff regarding Case Management sensitive data findings.
3.Identifies appropriate staffing levels, assignments, and deployment for the department.
4.Establishes role descriptions and performance criteria for staff members.
5.Identifies organizational needs and concerns in payer-provider contracts and contributes to related negotiations.
6.Establishes effective relationships with individual physicians, physician groups, and physician organizational structures.
7.Establishes processes and policies that adhere to Joint Commission standards as well as CMS Conditions of Participation and other regulations.
8.Collaborates with Compliance to ensure developed processes and policies meet compliance standards.
9.Establishes a Utilization Management Committee, participates in the selection of standing agenda items, and provides reports and data to be reviewed.
10. Develops structures and processes to facilitate participation by physicians, pharmacists, nurses, Social Workers and other health professionals in multidisciplinary care planning, care delivery, and discharge planning.
11. Establishes effective communication systems and forums with third party payers and the local QIO/PRO.
12. Develops and maintains effective relationships with hospital department heads, nursing managers and administrators, and the administrative staff.
13. Develops relationships with LHS accountable care organization as well as with outside preferred providers SNFS and Home Health Agencies etc.
14. Evaluates and optimizes patient satisfaction with discharge planning functions.
15. Directs utilization review activities for the hospital, interfacing with external payers and review companies to determine appropriate medical necessity of admissions and continued hospitalization.
16. Resolves conflicts related to discharge planning with patients/families, external agencies and payers.
17. Facilitates transition of patients/families across the continuum by establishing relationships with appropriate providers and community services.
18. Establishes policies, procedures and protocols for departmental functions.
19. Establishes a structure and process to address the CMS RAC initiative related issues within the organization that is aligned with other departments such as Finance and Compliance.
20. Responsible for implementation of policies and procedures related to hospital based case management, utilization review,


A. Develops implements and assures compliance with Nursing Practice Guidelines.

B. Encourages staff participation on Shared Governance Councils, nursing committees, and organization committees.

C. Maintains and displays knowledge of current professional/clinical issues and uses evidence based resources to implement necessary changes in the delivery of nursing care.

D. Collaborates with leadership team to provide opportunities for staff development. i.e.:

  • Participation in nursing research.

  • Certification in nursing field

  • Participation in professional organizations.


A. Links departmental goals to organizations mission and goals.

B. Works collaboratively to solve problems, improve processes and integrate services within the department and with other departments.

C. Supports new ideas and changes within the department by actively participating and contributing.

D. Demonstrates flexibility in meeting demands of the department.

E. Organizes and prioritizes work to meet deadlines.

F. Develops effective communication methods to keep staff and others informed about activities of the organization and department.


A. Proactively develops plans to meet future departmental/organizational needs.

B. Reviews outcome measures and works collaboratively with staff and leadership team to improve patient outcomes. Ie: National Database of Nursing Quality Indicators (NDNQI) and Core Measures

C. Collaborates with multi-disciplinary teams to:

  • Comply with regulatory standards

  • Improve patient satisfaction

  • Improve patient outcomes

  • Identify, assess, measure and systematically improve important processes and activities.


A. Works collaboratively with the Human Resources Department and Senior Leadership to recruit, hire and retain qualified personnel.

B. Oversees and conducts performance appraisals. Collaborates with Senior Leadership and Human Resources to recommend compensation adjustments.

C. Assures appropriate orientation, competence assessment, in-service training and continuing education for all staff.

D. Fosters staff development by assisting them to identify goals and appropriate opportunities for learning.

E. Encourages creativity and celebrates staff accomplishments.

F. Promotes an environment that is sensitive to the diverse needs of the patients and employees.

G. Coaches and supports staff by removing barriers and addressing issues.

H. Assures licensing certification for all staff is current.

I. Conducts regular staff meetings.

J. Communicates staffing concerns to Associate Chief.

K. Delegates work appropriately and provide direction and guidance to nursing and support staff.


A. Participates in development of annual departmental budgets.

B. Develops and implements cost effective staffing patterns.

C. Uses resources effectively to provide high quality cost effective services.

D. Monitors budget and prepares variance reports.

E. Maintains ANSOS and assures vacancy rate/position control is current.

F. Manages expenses on an on-going basis and identifies areas of potential cost savings.


A. Pursues self-awareness, actively seeks feedback, accepts constructive criticism, and modifies behavior accordingly.

B. Engages in professional development activities such as education, participating in professional associations, or other appropriate activities.

C. Maintains necessary continuing education requirements for license, certifications and enhancements.

D. Maintains own educational record.

E. Supports Lahey Clinics commitment to community based activities both within the Lahey community and beyond.


A. Incorporates Lahey Clinic Guiding Principles, Mission Statement and Goals into daily activities.

B. Complies with all Lahey Clinic Policies.

C. Complies with behavioral expectations of the department and Lahey Clinic.

D. Maintains courteous and effective interactions with colleagues and patients.

E. Demonstrates an understanding of the job description, performance expectations, and competency assessment.

F. Demonstrates a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.

G. Participates in departmental and/or interdepartmental quality improvement activities.

H. Participates in and successfully completes Mandatory Education.

I. Performs all other duties as needed or directed to meet the needs of the department.

Minimum Qualifications:

Education: Graduate of Approved/accredited School of nursing.

Licensure, Certification, Registration: Current licensure to practice professional nursing in the Commonwealth of Massachusetts.

Life Support Certification:

Special skills and knowledge required:
1.Knowledge of payer requirements and discharge planning regulations that support the effect development of departmental policies, procedures and standards.
2.Demonstrated ability to: Establish the goals, vision, and overall direction of a department; create and implement departmental standards, systems, staffing plan and processes; analyze issues and create and effective plan to address them; critically and comprehensively evaluate the department?s outcomes; identify, collect and analyze data related to the internal and external environment as well as departmental functioning; and, develop and educate staff.
3.Demonstrated ability to communicate verbally and in writing to internal and external constituencies.
4.Ability to establish priorities, meets deadlines, and develops and manages the department?s productivity standard in the management of work assignments.
5.Ability to form positive, collaborative relationships with members of the executive team, hospital staff, post-acute providers and p

Skills, Knowledge & Abilities:

Clinical Skills/Technical Knowledge

a. Demonstrates the necessary clinical competence in area of nursing practice.

b. Excellent interpersonal and organizational skills.

c. Basic computer skills.

Experience: A minimum of five years of accumulated in-patient nursing experience and two years leadership experience.


DAYS - 8 hour shifts Monday-Friday

About Us

The Lahey Model of Careright care, right time, right placeis exactly what patients, providers and payers need and deserve. Identifying and delivering on this convergence of interests has positioned Lahey Health for further growth. Our model ensures care is highly coordinated and locally delivered, with lower costs and exceptional quality.

Lahey Health is a robust, regional system including a teaching hospital, community hospitals, primary care providers, specialists, behavioral and home health services, skilled nursing and rehabilitation facilities, and senior care resources throughout northeastern Massachusetts and southern New Hampshire. The system has a global presence with programs in Canada, Jordan and Bermuda.

Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Case Manager

Beth Israel Lahey Health

Posted 2 weeks ago

VIEW JOBS 10/3/2019 12:00:00 AM 2020-01-01T00:00 Welcome To Welcome to Lahey Hospital & Medical Center, part of Beth Israel Lahey Health. Lahey Hospital & Medical Center is a world-renowned tertiary medical center known for its innovative technology, pioneering medical treatment and leading-edge research. A teaching hospital of Tufts University School of Medicine, the hospital provides quality health care in virtually every specialty and subspecialty, from primary care to cancer diagnosis and treatment to kidney and liver transplantation. It is a national leader in a number of health care areas, including stroke, weight management and lung screenings, among many others. Lahey also helps to advance medicine through research and the education of tomorrow's health care leaders. Scheduled Hours Per Diem Responsibilities Position Summary: The inpatient Case Manager assigned by nursing unit coordinates utilization review, discharge planning and monitors quality assurance for Lahey Clinic inpatient admissions. Leads the multidisciplinary team to ensure a timely process. Essential Duties & Responsibilities including but not limited to: 1) Performs utilization review and discharge planning to inpatient admissions. 2) Applies Interqual, AEP and or other review criteria approved by the Clinic to accurately determine appropriateness for inpatient and outpatient care. 3) Utilizes clinical expertise to determine the appropriate level of care for patients. Leads the healthcare team in selecting appropriate, safe, hospital or alternative care options. 4) Works closely with Community Case Managers to collaborate regarding medically fragile and or high risk patients admitted to the clinic. 5) Identifies delay days and notifies Team Leader. 6) Reports serious occurrences and sentinel events to Risk Management. 7) Works with patients and families to facilitate post hospital care and develop plans to meet short and long-term needs. 8) Accurately manages observation status patients by working with physicians to ensure appropriate utilization. 9) Is part of the department's Saturday, Sunday, holiday and beeper rotation as needed. 10) Supports all service line activities related to utilization and quality management. 11) Assists in the development and implementation of clinical pathways. 12) Adheres to all insurance, contractual and regulatory requirements as mandated. 13) Works with Lahey Clinic nursing, social work and other members of the healthcare team to coordinate and facilitate patient discharge. 14) Works with the Post Acute Care Coordinator to facilitate timely patient access to post acute care Services. 15) Participates in hospital or medical committees representing patient issues and department functions such as case management, utilization and CQI as requested. 16) Incorporates Lahey Clinic Guiding Principles , Mission Statement and Goals into daily activities. 17) Complies with all Lahey Clinic Policies. 18) Complies with behavioral expectations of the department and Lahey Clinic. 19) Maintains courteous and effective interactions with colleagues and patients. 20) Demonstrates an understanding of the job description, performance expectations, and competency assessment. 21) Demonstrates a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards. 22) Participates in departmental and/or interdepartmental quality improvement activities. 23) Participates in and successfully completes Mandatory Education. 17) Performs all other duties as needed or directed to meet the needs of the department. Qualifications Minimum Qualifications: Education: * Registered Nurse, Bachelors Degree or commensurate experience preferred. Licensure, Certification, Registration: * Must hold current Commonwealth of Massachusetts license as a Registered Nurse, and Basic Life Support (BLS) Skills, Knowledge & Abilities: In the absence of any of these skills, demonstrates the ability to be thoroughly trained to Proven leadership and project management experience and skill meet organizational standards. * Effective verbal communication, problem solving and conflict resolution skills. * Basic computer and typing skills. * Basic knowledge of Quality Improvement techniques. * Demonstrated ability to organize and work independently Experience: * A minimum of three years of medical/surgical nursing care experience. Two years of case management or utilization management experience desirable. * Demonstrated ability to communicate effectively with medical and hospital staffs. Beth Israel Lahey Health Burlington MA

Nurse Manager Case Management

Winchester Hospital