Case Manager

RN Care Manager

Utilizing a collaborative process the care manager will assess plan implement monitor and evaluate the options and services required to meet an individuals 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 Care Manager

Department: Emergency Department

Schedule: 30 Hours (Day/Evening)

Job Requirements

Education:

Nursing degree: Diploma ASN or BSN (preferred) Ability to obtain BSN within 4 years

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:

3-5 years of diversified clinical experience including care management is required

ED experience preferred

A minimum of 2 years of previous experience involving judgment and decision making preferably in a utilization management/case management position

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 are 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 negotiations skills

Strong analytical data management and PC skills