Case Manager - Social Services
Apply for the Case Manager - Social Services role at Berkshire Health Systems .
Responsibilities
Manages healthcare needs, facilitation, and quality & cost outcomes for all patients at Berkshire Medical Center using a multidisciplinary team approach. Negotiates, procures, coordinates, and monitors services and resources needed by patients. Reviews patients at admission and continues throughout hospitalization. Performs transition care planning activities to secure appropriate post‑hospital care arrangements and monitors patient during hospital stay.
Participates in performance improvement initiatives undertaken by Berkshire Health Systems.
Qualifications
Experience – Minimum 3 years clinical experience in acute care (internal medicine, surgery, orthopedics, mother/child, cardiology, oncology). Additional 3 years in Rehab, Home Health, or Long‑Term Care considered.
Case Management & Utilization Management – Experience required for weekend, temporary, and per diem positions. Must specialize in utilization management, discharge planning across continuum of care, with evidence‑based criteria tools. Prior care management or third‑party insurance review necessary.
Knowledge – Current knowledge of CMS level‑of‑care determinations, appeal rights, DPH regulations, Ma Pro QIO appeals. Familiarity with regulations and accreditation organizations (Joint Commission, DPH, HealthGrades) preferred.
Education & Training – Associate degree in Nursing required; Bachelor’s degree in Nursing within four years of hire preferred.
License, Certification & Registration – Registered Nurse licensed in Massachusetts; CPR; CASEMGMT – CCM, ACM, or RN‑BC within two years of hire.
Other Requirements – Organizational, analytical, and managerial skills; excellent interpersonal, communication, confidentiality, collaboration, negotiation, independent work, relationship building with physicians. Knowledge of local community resources and Medicare/Medicaid/third‑party payers required. Computer literacy, experience managing multiple applications, data comprehension and reporting skills.