Complex Care Manager, RN

Serves as a core member of the care team coordinates and supports healthcare within the facility, and coordinates referrals for services outside the clinic. Provides outreach and enrollment services to meet eligibility requirements of the program and surrounding counties. Ensures coordination and planning, including community and family support. Focuses on the development and coordination of community service plans. Partners with service providers, families, and patients to create a plan of healthcare and identify additional service providers.Essential Functions:-Client Assessments and Planning.-Modify patient treatment plans as indicated by patients' responses and conditions. -Prepare patient/family for discharge.-Communicates with third party payers to obtain necessary authorization for reimbursement of services.-Review cases with medical directors on challenging cases as needed.-Defines care goals of patients by providing education, information, and direction to each individual and family. -Maintain accurate, detailed reports and records. -Communicates with third party payers to obtain necessary authorization for reimbursement of services.

Qualifications:

• Associate's Degree Nursing or Bachelor's Degree Nursing required

• Massachusetts Registered Nurse (RN) License

• 2+ years case management, utilization review, discharge planning or home care experience strongly preferred

Additional Knowledge, Skills and Abilities:

- Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
- Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
- Ability to establish strong rapport and relationships with patients and staff.
- Proficient in Microsoft Office and industry related software programs.
- Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
- Ability to maintain client and staff confidentiality.
- Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care.
- Knowledge of Healthcare and Managed Care preferred.

Schedule and Work Model:

• Full-time Monday through Friday, approximately 8am-4:30pm; some flexibility with hours.

• Primarily remote

• Meetings at Assembly Row in Somerville, MA twice per month.

• On remote workdays, employees must use a stable, secure, and compliant workstation in a quiet environment. Teams Video is required and must be accessed using MGB-provided equipment.

Mass General Brigham Community Physicians, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.

Required

Preferred

Job Industries

• Other