Overview
Nurse Case Manager – Brown University Health
Summary
Promotes development of high‑quality patient care in an effective setting, balancing patient and hospital advocacy. The role requires knowledge of third‑party payor issues and exemplifies the organization’s values of Compassion, Accountability, Respect, and Excellence.
Responsibilities
Coordinate patient care across the continuum, maximizing internal and external resources.
Provide a nursing assessment within 24‑48 hours of admission for clinically oriented services focused on mobilization.
Identify problems and gaps in patient care, suggest interventions, expedite interdisciplinary referrals, and ensure timely diagnostic testing.
Participate in patient care conferences and work collaboratively with medical staff, nursing, and therapeutic disciplines to develop and implement care plans.
Initiate and document patient care plans, progress, goals, and interventions in accordance with Case Management Department and state guidelines.
Maintain professional relationships with Managed Care organizations, reviewers, and external agencies; return all calls during coverage.
Monitor utilization of resources, intervene with physicians and therapeutic disciplines to remove barriers affecting length of stay.
Communicate issues identified via Allscripts to the unit case manager and demonstrate awareness of resource utilization.
Apply severity of illness/intensity of service criteria and identify appropriate levels of care for assigned cases.
Demonstrate initiative in reducing length of stay and resource consumption among complex case‑managed patients.
Assist physicians in resolving external payor issues and coordinate services/resources per payor guidelines.
Establish contact with patients/families within required timelines, explain the case management role, and identify expected length of stay.
Manage transitions through systems and transfer accountability to appropriate agencies upon discharge.
Participate in data collection and quality monitoring of resource utilization and outlier stays.
Attend department meetings and contribute to discussions and resolution of issues; maintain accurate statistical data.
Stay current with federal, state, and community resources for patients and families.
Qualifications
Knowledge of disease management.
Three to five years of acute‑care nursing experience, or one to three years in utilization review / discharge planning (preferred).
Bachelor of Nursing degree required; significant case‑management experience considered in lieu of a Bachelor degree.
Current MA RN license.
Education
Bachelor of Nursing Degree (BSN). Significant case‑management experience may be considered if a BSN is not held.
Pay Range
Competitive salary commensurate with experience.
EEO Statement
Brown University Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, ancestry, genetics, gender identity or expression, disability, protected veteran, or marital status. Brown University Health is a VEVRAA Federal Contractor.