Registered Nurse, Case Manager, Per Diem

Are you an internal caregiver, student, or contingent worker/agency worker at UMass Memorial Health?  to apply through your Workday account.

Exemption Status:

Non-Exempt Hiring Range:$44.06 - $79.30(based on a full time schedule of 40 hours per week).Please note that the final offer will vary based on scheduled hours. Compensation for part-time or reduced schedules will be prorated based on scheduled weekly hours, experience, skills, qualifications, and internal equity considerations.

Schedule Details:

Holidays
- One Major Summer Holiday, Holidays
- One Major Winter Holiday, Sunday through Saturday, Weekends
- One Full Weekend a Month Scheduled

Hours:

8:00am to 4:30pmShift: 1 - Day Shift, 8 Hours (United States of America)

Hours:

0

Cost Center:10021 - 4402 Case Management This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other.

And everyone, in their own unique way, plays an important part, every day.

Responsible for identifying individual patient needs and developing plans of care as well as engaging and integrating appropriate resources for optimal clinical and financial patient outcomes. Responsible for the efficient collection of meaningful clinical and utilization data to effectively support care coordination initiatives

I. Major Responsibilities:
1. Performs assessment of patient’s physical, functional, and psycho-social needs through the use of screening tools, direct patient and family communication, medical record review, and discussions with other care givers providing services to the patient. Identifies complex patients in need of intensive case management based on established clinical and financial criteria.
2. Performs admission and concurrent reviews as assigned. Performs inpatient reviews in accordance with payer requirements utilizing clinical criteria sets. Meets with 3rd party case managers to discuss cases and assures timely communication of relevant clinical information to third party payers as required. Educates practitioners on the level of care and documentation requirements.
3. Collaboratively facilitates the care of patients throughout the continuum of care. Works as a team member to support /collaborate with Care Coordination Team for monitoring level of care, and for identification of trends in clinical practices and opportunities for improvement.
4. Works with patients and families to establish objectives, goals and an action plan to meet the patient’s individual needs within the indicated level of care. Collaborates with the physicians, other care providers and community resources in the care planning process.
5. Contacts third party payer to clarify benefit eligibility, coverage, and available resources for patients. May negotiate conversion of benefits for previously non-covered services. Researches alternate sources of funding for non-reimbursed services that are part of the patient’s treatment plan.
6. Coordinates, implements, monitors and evaluates outcomes of the discharge plan. Evaluates progress of this plan with the discharge planner, patient, family and the patient’s health care insurer. Goals, interventions and time frames are revised as needed as a means of assisting the patient to achieve his/her optimal…