RN-Complex Case Manager

Job Profile Summary

This role focuses on providing professional and nonprofessional nursing care services in accordance with physician orders. In addition, this role focuses on performing the following Care Manager related duties: Works as part of a multidisciplinary team to coordinate their patient's care in an effort to improve patient outcomes and create efficiencies. A professional individual contributor role that may direct the work of other lower level professionals or manage processes and programs. The majority of time is spent overseeing the design, implementation or delivery of processes, programs and policies using specialized knowledge and skills typically acquired through advanced education. A senior level role that requires advanced knowledge of job area typically obtained through advanced education and work experience. Typically responsible for: managing projects / processes, working independently with limited supervision, coaching and reviewing the work of lower level professionals, resolving difficult and sometimes complex problems.

Location: Main Campus

Hours: Hours, Full Time 40 Hours

Job Overview

The position manages a designated caseload of high acuity patients to coordinate, plan, implement, and evaluate discharge plans and care transitions across the continuum of care. The position will work as part of a multidisciplinary team to provide education and guidance in the discharge planning of our complex care patients.

Job Description

Minimum Qualifications:
1. Massachusetts RN Licensure.

2. 3 Years of RN Experience.

3. Current Basic Life Support (BLS) Certification.

Preferred Qualifications:

1. Bachelor of Science in Nursing (BSN).

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list.Other duties and responsibilities may be assigned.

• Interviews and collects specific information and data from patients and families, contributes to the identification of specific physical, emotional, educational and cultural needs of those patients.
• Maintains documentation of assessment findings, discharge arrangements, and actions taken according to departmental guidelines.
• Completes a discharge assessment, to include appropriate documentation, according to established policies and procedures.
• Resource support to frontline case management staff for complex discharge planning issues when barriers are identified.
• Maintains up-to-date list of Complex Care patients with discharge barriers identified and ongoing efforts to remove these barriers.
• Identifies expected outcomes individualized to the patients identified on the Complex Care list.
• Contributes to the development of effective care interventions and tools for the Complex Care Program.
• As primary Case Manager for identified complex patients, facilitates communication with the patient's multidisciplinary team, to develop a clear Plan of Care.
• Implements the plan of care to achieve the identified expected outcomes for Complex Care patients.
• Develops and maintains affinity between all supporting departments, clinical areas, and community partners, thus producing high performing, patient focused teamwork.
• Leads weekly Complex Case Meeting with updates to interdisciplinary team to identify potential solutions to discharge barriers.
• Escalate highly complex issues to COC leadership.
• Utilizes community and other resources and systems to implement the plan facilitating referrals when appropriate.
• Coordinates activities related to financial/insurance issues, including providing clinical updates to insurance companies.
• Coordinates insurance appeals related to discharges and adhering to policies and procedures of Medicare and Medicaid.
• Assists in achieving unit quality scores which meet or exceed hospital established targets for nurse sensitive quality indicators as appropriate for the unit.
• Updates clinical leaders daily with ongoing discharge planning efforts for Complex Care patients.