Overview Utilizing a collaborative process, the care manager will assess, plan, implement, monitor, and evaluate the options and services required to meet an individual's health needs, using communication and available resources to promote quality, cost-effective outcomes. The care manager helps identify appropriate providers and facilities throughout the continuum of services while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the patient and the reimbursement source. This care manager is dedicated to handle the increased volume and to support the overall care management process and the department.
Position: RN Case Manager
Department: 4W
Schedule: 40 Hours (Days / 4x10 Hour Shifts / Every 6th Weekend)
Qualifications
Education
Graduate of an accredited ASN/BSN Program in Nursing
Certificates, Licenses, Registrations Required
Licensed to practice as a Registered Nurse in the Commonwealth of Massachusetts
CCM or related certification attained within 24 months from the hire date is preferred
Experience
BSN preferred and MA RN license required
A minimum of 3-5 years recent clinical experience required
A minimum of 1-3 years recent acute inpatient Care Management experience required
Strong communication, collaboration, and problem-solving skills
Knowledge of utilization review, discharge planning, managed care, and community resources
Knowledge and Skills
Extensive background and knowledge of current medical/surgical patterns of practice
Medical terminology and standard medical abbreviations
Managed care concepts, the various health care delivery systems
Methods for assessing an individual's level of physical/mental impairment, understanding of the physical and psychological characteristics of illness, and understanding of expected treatment
Confidentiality issues and the legal and ethical issues pertaining to them
ICD-9 and CPT nomenclature and the ability to interpret and convert this information, as applicable
Knowledge of benefits and various plan contracts, eligibility issues and requirements
Role and functional responsibilities of case management professional; case management program philosophy and purpose within Managed Care Program
Excellent interpersonal, verbal and written communication and negotiation skills
Strong analytical, data management and PC skills
Equal Opportunity Employer/Disabled/Veterans
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