Registered Nurse Case Manager; RN

Overview Who We Are

We are a community built on care. Our caregivers and supporting staff extend compassion to those in need, helping to improve the health and well-being of those we serve, and provide comfort and healing. Your community is our community.

We started out as a small operation in California. In May 1969, we acquired four hospitals, some additional care facilities and real estate for the future development of hospitals. Over the years, we've grown tremendously in size, scope and capability, building a home in new markets over time, and curating those homes to provide a compassionate environment for those entrusting us with their care.

Today, we are leading health system and services platform that continues to evolve in lockstep with community need. Tenet's operations include three businesses - our hospitals and physicians, USPI and Conifer Health Solutions. Our impact spreads far and deep with 65 hospitals and approximately 510 outpatient centers and additional sites of care. We are differentiated by our top notch medical specialists and service lines that are tailored within each community we serve.

The work Conifer is doing will help provide the foundation for better health for clients across the country, through the delivery of healthcare-focused revenue cycle management and value-based care solutions. Together as an enterprise, we work to save lives and can accept nothing less than excellence from ourselves in service of our patients and their families, every day.

Metro West Medical Center is the largest community health care system between Worcester and Boston. Metro West Medical Center is committed to providing high quality, comprehensive care, at a location close to home. The 307-bed regional healthcare system includes Framingham Union Hospital, Leonard Morse Hospital in Natick and the Metro West Wellness Center. Metro West Medical Center has been named to the 2019 America’s 100 Best Hospitals List by Health grades.

Please be advised that candidates must successfully complete a background check and pre-employment health screening which includes a drug screen.

The RN Case Manager is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to promote timely throughput, safe discharge, and prevent avoidable readmissions.

This position integrates national standards for case management scope of services including:
Utilization Management supporting medical necessity and denial prevention;
Transition Management promoting appropriate length of stay, readmission prevention, and patient satisfaction;
Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care;
Compliance with state and federal regulatory requirements, TJC accreditation standards, and Tenet policy;
Education provided to physicians, patients, families and caregivers.

• Accurate medical necessity screening and submission for Physician Advisor review
• Care coordination
• Transition planning assessment and reassessment
• Implementation or oversight of the transition plan
• Leading and facilitating multi-disciplinary patient care conferences
• Managing concurrent disputes
• Making appropriate referrals to other departments
• Identifying and referring complex patients to Social Work Services
• Communicating with patients and families about the plan of care
• Collaborating with physicians, office staff and ancillary departments
• Leading and facilitating Complex Case Review
• Assuring patient education is completed to support post-acute needs
• Timely complete and concise documentation in Case Management system
• Maintenance of accurate patient demographic and insurance information
• Identification and…