Summary

The Hospital Sr Case Manager is a registered professional nurse who facilitates and enhances collaboration with patients, families, physicians and healthcare providers to ensure patients receive the services required to improve healthcare outcomes and quality of life.  The Hospital Case Manager seeks to ensure that quality care is provided to patients and is an active participant in the process to improve operational efficiency and patient outcomes. 

The Hospital Sr Case Manager participates in the implementation of a patient-centered plan of care.  Coordinates input from all health care professionals conducts assessments of patient and family needs, and facilitates and documents the discharge plan, assuring continuity of care.  The Hospital Case Manager utilizes appropriate case management tools to coordinate the appropriate resources for safe and quality hospital transition, in alignment with medical management initiatives and product line goals.  Evaluates the appropriateness of admissions and continued stay using approved criteria.  Collaborates with payers through ongoing written and verbal communication to optimize the reimbursement potential for all Baystate Health hospitals.  Adheres to system and department Compliance policies, and any applicable laws and regulations.  Provides quality case management coverage 7 days a week

Requirements

1) Uses Case Management skills to ensure quality patient-centered care is achieved.  Utilizes effective communication with peers, patients, and families. Performs daily review of cases and makes appropriate recommendations to the care team for practice guideline utilization, LoS, and quality of care.  Recognizes the case manager's role in assessing, facilitating, collaborating, and coordinating patient services through the continuum of care.  Effectively collaborates with others on the healthcare team to resolve patient care issues.  Applies utilization criteria correctly and responsibly to best portray the process of care delivery for all BH hospitals.  Identifies appropriateness of admission and concurrent days of stay.  Provides verbal and written notices of non-coverage to patients and/or their representatives, in accordance with departmental policies and third-party regulations

2) As applicable, communicate effectively and efficiently with insurance companies to avoid the denial/appeal process whenever possible.  Understands the role of the Physician Advisor for Case Management and makes appropriate referrals for review.  Provides a clear and concise review.  Ensures CM leadership informed on issues of prolonged LOS, patient/family concerns, and insurance payment issues

3) Provides post-acute hospital care planning/discharge facilitation.  Proactively works with the healthcare team to identify those patients who will need some level of care following their acute hospitalization.  Involves patients/families in the discharge planning process to facilitate a clear understanding by all parties.  Monitors each patient’s discharge plan of care for variance makes appropriate recommendations and revises the plan as necessary.  Assures that interventions are in alignment with medical management initiatives.  Provides appropriate financial/regulatory information to patients and/or families including scope of reimbursement sources.  Follows all state and federal guidelines in regard to patient rights in planning for their post-acute needs

4) Demonstrates strong clinical knowledge as part of the healthcare team to ensure quality, evidence-based care is delivered.  Demonstrates strong clinical knowledge of the patient population being managed.  Continually seek to develop their body of clinical knowledge.  Serves as a resource to members of the healthcare team.

5) Collaborates with community case managers and other health care advisors to ensure a smooth and safe continuum of care plan. Provides timely documentation of the post-acute care plan in the medical record.

6) Conducts extensive assessments and implements interventions for patients at risk for readmission

7) Active participant in daily unit progression rounds with interdisciplinary teams to direct timely care progression along the continuum; focusing on appropriate GMLOS.

8) Assumes Responsibility for Own Professional Growth.  Attends educational programs to maintain current knowledge in utilization management, discharge planning, and case management with specific emphasis on own areas of responsibility. Attends educational program to maintain knowledge of current clinical management of patient problems in assigned clinical areas.  Establishes annual goals for professional growth and seeks opportunities that lead to the accomplishment of these goals. 

9) Attends regularly scheduled departmental meetings as guided by the department manager and/or supervisor. Presents new topics and ideas at meetings as requested by the manager.

10) As needed, the BH RN Sr Case Manager will provide education and orientation services to new CMs, be called upon when their experience and strong clinical knowledge are needed to assist in other areas, and serve as a resource for all other staff.

11) Serve as a resource for first-level troubleshooting for challenges for their team

12) Serves as a weekend/holiday leader resource for the CM team as needed

13) Functions as a superuser for new programs and services and functions as train the trainer in appropriate settings.

14) The BH RN Sr Case Manager serves as a mentor to less experienced case managers, leads by example, and demonstrates Baystate's Core Competencies with the ability to critically think, problem solve and successfully coordinate the care of medically/socially complex patients with autonomy.

Required Experience

3 or more years of Case Manager experience

1 year Case Manager at Baystate Health

Preferred Experience

Leadership experience

Transitional Care Experience

Education

Bachelor's Degree required

Applicable experience and an Associate's of Nursing may substitute the Bachelor's Degree

Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries may vary by position and will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range. Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees.

Minimum - Midpoint - Maximum

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.