RN Case Coordinator- Oncology BWH

Ambulatory Oncology Case Manager/ RN Care Coordinator

The Brigham and Women's Hospital, Inc.

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

The ambulatory oncology case manager is a vital link in providing patients with access to services and treatments needed along the cancer care journey. The case management team is responsible for coordination of services needed in the home, including but not limited to, VNA, hydration services, oxygen and durable medical equipment. Additionally, the CM team is highly knowledgeable and skilled in obtaining prior authorizations for certain medications and treatments. All coordination is documented in the electronic health record to provide transparency to all the care providers on the patient's team. The case management team collaborates with physicians, APPs, ambulatory practice RN's, pharmacies, other outside vendors/agencies and most importantly, patients and families.

The qualified candidate will have foundational knowledge in oncology care. The willingness and ability to learn the intricacies of insurance regulations, including state and federal Medicare/Medicaid policies. Additional training includes understanding the needs of various oncology patient populations, such as those with solid tumors, hematologic malignancies, bone marrow transplants, classical hematology, sickle cell disease, and others. The ideal candidate will demonstrate robust patient advocacy and exhibit exemplary professional communication skills in all interactions.

Working closely with high-risk patients, the Ambulatory RN Care Coordinator is responsible for establishing, implementing, monitoring, and evaluating high-quality, cost-effective care plans. The Ambulatory RNCC collaborates with practice Physicians and Program leadership, strategizing about optimal and efficient patient care plans and approaches. The Ambulatory RNCC remains knowledgeable about performance targets established via the Program Leadership Team and strives to achieve these goals. This position requires a broad knowledge of clinical care and systems management, case management expertise, prudent nursing judgment, health care reimbursement, sound problem-solving skills, independent thinking, excellent organizational and interpersonal skills, creativity, flexibility, and the ability to multitask. Working Conditions: Works in a busy and, at times, stressful office or health center environment. Must be autonomous, industrious, and work well in a multi-disciplinary group. Flexibility is required. Must be a team player, prepared to cover for colleagues as needed. Some travel to the hospital, post-acute settings, other offices, and patient homes at times. For newly licensed nurses, a Bachelor of Science Degree in Nursing is required.

Ages of all patient populations served:

• Young Adult (18 to 25 years)
• Adult (26 to 54 years)
• Senior Adult (55 to 64 years)
• Geriatric (65 years and up)

Does this position require Patient Care? Yes

Essential Functions

• Performs program-specific patient outreach, education, and recruitment.
• Consults with patients' physicians and/or Medical Directors about high-priority patients and potential care management plans.
• Initiates telephone or in-person contact with eligible patients to perform initial assessment, healthcare education, and develop a realistic care management plan.
• Incorporates knowledge of case management, levels of care, and utilization management principles to implement high-quality, cost-effective care plans.
• Utilizes excellent interpersonal skills when communicating with patients, families, and physicians in order to develop rapport, build trust, and engage patients in health promotion activities.
• Influences utilization of health care resources by providing direct care coordination to patients, encouraging enrollment in disease and case management programs, providing care coordination intervention and follow-up prior to and after interaction with health care system, e.g., inpatient, ED visit, outpatient services, etc.
• Using medical management criteria or other diagnostic screening criteria, determines appropriateness of hospital admissions and disease management programs. As indicated, provides direct and ongoing care management to select patients and/or refers to existing care management programs: insurance-based specialty case management programs, BWPO Disease Management programs, Partners HealthCare Disease Management programs, etc.
• Communicates with other health care clinicians throughout the continuum about patient's care, utilization, and follow-up plans, e.g., ED Care Facilitators, inpatient Care Coordinators, post-acute case managers, social workers, pharmacists, etc.
• Establishes a consistent communication and reporting schedule for periodic contact with providers and patients to review patient status and progress toward goals.
• Notifies Nursing Director, PCP, MD Advocate, and/or Medical Director about (over/under) utilization of services and patient's compliance with program.
• Collaborates with PCP, MD Advocate, and/or Medical Director, re. challenging patient situations.
• Acts as clinical resource person for program's quality efforts.
• Attends and presents case reviews at practice meetings, program meetings, and care coordination meetings.
• Utilizes care management systems to document, monitor, and evaluate patient interventions and care plans.
• Keeps current with related trends in care management, including health education and coaching.
• Participates in regular meetings with the Nursing Director and Medical Director to review performance, patient volume, projects, outside professional activities, and upcoming goals to achieve.

Organizational Responsibilities

• Demonstrates a positive attitude in dealing with problems or crisis situations.
• Is aware of and follows BWH policies and procedures for general safety, fire safety, parking, proper body mechanics, infection control, attendance, punctuality, and appearance.
• Works effectively with team members.
• Demonstrates initiative and creativity to continuously improve services, processes, and other activities that affect quality and utilization.
• Performs all duties in an independent, professional manner and requests assistance when necessary.
• Work reflects excellent organizational skills.
• Willingness to be flexible in situations.
• Performs duties of lesser, equal, or greater responsibility as requested.

Other Duties and Responsibilities

• Assumes accountability for professional growth and development.
• Exemplifies program teachings and acts as a role model for patients by practicing behaviors consistent with goals of the program.
• Assists in preparation for Joint Commission, CMS, and other surveys as applicable to role.
• Works within legal, regulatory, accreditation and ethical practice standards relevant to the position and as established by BWH/Partners.
• Follows safe practices required for the position.
• Complies with appropriate BWH and Partners policies and procedures.
• Fulfills any training required by BWH and/or Partners, as appropriate.
• Brings potential matters of non-compliance to the attention of the supervisor or other appropriate hospital staff.

Qualifications

Education

• Bachelor's Degree Nursing required and Master's Degree Nursing preferred. BSN required for newly licensed nurses. Can this role accept experience in lieu of a degree? Yes.

Licenses and Credentials

• Current licensure as Registered Nurse in Commonwealth of Massachusetts Required.

Experience

• 1. Minimum 13 years of oncology care experience within the past five (5) years required.
• 2. Minimum 1 year case management experience in an outpatient setting within the past five (5) years required
• 3. Experience with complex patient populations (e.g., solid tumors, hematologic malignancies, BMT) strongly preferred.
• 4. Health care re-reimbursement experience strongly preferred.
• 5. Knowledge of insurance authorization processes and healthcare systems strongly preferred.

Knowledge, Skills and Abilities

• Excellent organizational and communication skills.
• Excellent oral, written, and telephonic skills and abilities.
• Superior inter-personal skills.
• Strong competency working with hospital computer systems and case management systems.
• Competent using Microsoft Word, PowerPoint, and Excel.
• Ability to work well with physicians and ambulatory staff in a practice or health center setting.
• Demonstrated ability to present and speak in front of groups.
• Knowledge and skills to differentiate levels of care.