Registered Nurse - Case Manager

Description Registered Nurse Case Manager needed for a temp to perm job in Braintree, Mass. Works with an interdisciplinary team, guiding treatment plans based on patient needs and preferences.

Facilitates the development of a safe and effective plan of care through early identification and thorough assessment of the patients needs and resources available. Promotes effective interdisciplinary team dynamics, communication and facilitates a positive working environment to achieve desired outcomes. Reviews therapy intensity report daily to identify patient non-compliance trends.

Coordinates with interdisciplinary team to establish tentative discharge plan and contingency plans. Incorporates information from initial interviews and consultation with team and patient/family. Establishes contingency discharge plans for high-risk cases.

Actively identifies barriers to discharge plan and communicates with patient/family and team to decrease or eliminate such barriers. Accurately updates and maintains discharge calendar. Participates in planning for, and ensures successful execution of, patient discharge experience.

Confirms final discharge plans after consultation with team and patient. Prepares and reviews case management discharge paperwork and reviews with patient/representative at least 24 hours prior to discharge. Monitors patient experience: quality/timeliness/service appropriateness/payors/expectations.

Promotes informed decision-making through explanation of choices, risks, and benefits to the patient/family member and interdisciplinary team. Facilitates team conferences weekly and coordinates all treatment plan modifications. Identifies potential complications related to patient care and discharge plan after initial and ongoing team conferences.

Completes case management addendums and all required documentation. Manages documentation such as, but not limited to, contact notes, Interdisciplinary Plan of Care (IPOC), team conference form, family conference, continues stay reviews and discharge instructions. Maintains knowledge of regulation/standards, company policies/procedures, and department operations.

Maintains knowledge regarding state laws regarding competency and guardianship. Demonstrates understanding of the hospitals patient outcomes and financial goals and the departments impact on goal achievement. Incorporates knowledge of independence scoring process to evaluate accuracy of scores throughout length of stay.

Uses RAND methodology to establish Length of Stay management to promote the effective utilization of hospital days or services and conduct timely reviews as needed. Notify supervisor, business office, and patient of any coverage issues as they arise. Identifies the estimated LOS through RAND reports and will communicate this time frame to patient/family and interdisciplinary team.

Reviews/analyze case management reports including Key Care Indicators; plans appropriate actions. Keeps supervisor informed of reports, Key Care Indicators, and plan adjustments. Understands commercial contract levels, exclusions, payor requirements, and recertification needs.

Obtains precertification/authorization from third party payors for noncontractual services, including but not limited to radiology, day hospital services, hematology testing, transportation, outside tests, orthotics/prosthetics. Demonstrates working knowledge of reimbursement parameters of payors, and effectively educates patients, family, and staff on payor issues. Completes daily rounds to visit with each License or Certification:

Must be qualified to independently complete an assessment within the scope of practice of his/her discipline (for example, RN, SW, OT, PT, ST, and Rehabilitation Counseling). If licensure is required for ones discipline within the state, individuals must hold an active license. Must meet eligibility requirements for CCM® or ACM certification upon entry into this position OR within two years of entry into the position. CCM® or ACM certification required OR must be obtained within two years of being placed in the Case Manager II position.

Minimum Qualifications: For Nursing, you must possess minimum of an Associate Degree in Nursing, RN licensure with BSN preferred. A diploma is acceptable only in those states whose minimum requirement for licensure or certification is a diploma rather than an associate degree.

For all other eligible licensed or certified health care professionals, must possess a minimum of a bachelors degree and graduate degree is preferred. 2 years of rehabilitation 250 Pond Rd. Braintree, 02184