RN Case Manager - MGH

Summary
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 the program's eligibility requirements and those of the 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.
Does this position require Patient Care?
Yes
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 as needed to discuss challenging cases. >
-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.
5 - 8 hour shifts with one weekend commitment a month

Education
Associate's Degree Nursing required or Bachelor's Degree Nursing preferred

Can this role accept experience in lieu of a degree?
No

Licenses and Credentials
MA Registered Nurse License required

Basic Life Support [BLS Certification] - Data Conversion - Various Issuers preferred

Experience
Case management, utilization review, or discharge planning experience 2-3 years preferred

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. The General Hospital Corporation 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.