RN Case Manager - Per Diem

Site : Nantucket Cottage Hospital

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.

The RN Case Manager is responsible for helping to provide professional assessment, planning, coordination under the guidance of the department manager to ensure the provision of quality patient care, effective utilization of available health services, review of the medical necessity of admissions, and necessity for continued stay in the hospital; analyzing patient records to ensure compliance with government and insurance company reimbursement policies; ensuring compliance with insurance, governmental, and accrediting agency standards; submission of data to required agencies; and determining patient review dates according to established diagnostic criteria. May assist the review committee in planning and holding federally mandated quality assurance reviews.

Job 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 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.

Qualifications

Essential Functions (Key Roles & Responsibilities)

• 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.
• Performs other duties as assigned
• Complies with all policies and standards

Qualifications

Education Required / Preferred

Associate's Degree Nursing required

or

Bachelor's Degree Nursing preferred

Can this role accept experience in lieu of Education requirements?

No

Licenses / Certifications Required / Preferred

MA Registered Nurse license

Basic Life Support

Work Experience

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

Can this role accept experience in lieu of Education requirements?

No

Knowledge, Skills And Abilities

Additional Job Details (if Applicable)

Remote Type

Hybrid

Work Location

57 Prospect Street

Scheduled Weekly Hours

Employee Type

Per Diem

Work Shift

Day (United States of America)

Pay Range

$28.20 - $68.49 / Hourly

Grade

98TEMP

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement

Nantucket Cottage Hospital is an Equal Opportunity Employer. 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.