Case Manager - Social Services

Case Manager - Social Services

at Berkshire Health Systems

Rotation: rotating weekends, rotating holidays.

• Manage healthcare needs, facilitation and achievement of quality and cost outcomes of all patients within Berkshire Medical Center across the continuum.
• Utilize a multidisciplinary team approach to negotiate, procure, coordinate and monitor services and resources needed by patients.
• Review patient at admission, and in some instances prior to admission, and concurrently throughout the hospital stay for appropriate level of care and resource utilization.
• Perform transition care planning activities to secure appropriate post‑hospital care arrangements and monitor the patient during the hospitalization.
• Participate with performance improvement initiatives undertaken by Berkshire Health Systems.

• Three years clinical experience in acute care in areas such as internal medicine, surgery, orthopedics, mother/child, cardiology, and oncology.
• Three years clinical experience in Rehab Setting, Home Health and Long‑Term Care would be considered.
• Ability to perform comprehensive admission and discharge risk assessment related to quality, financial, payer benefit allowances and limitations, risk management and patient satisfaction.
• Case Management experience required for weekend, temporary and per diem positions.
• Experience in utilization management, discharge planning, previous care management or third‑party insurance review required.
• Current knowledge of CMS levels of care determinations, appeal rights & DPH regulations required.
• Current knowledge of Ma Pro QIO appeals required.
• Knowledge of regulatory and accreditation organizations such as Joint Commission, DPH and Health Grades preferred.

• Associate degree in Nursing required;
  Bachelor’s Degree in Nursing within four years of hire preferred.
• Licensed RN in Massachusetts.
• CPR certification.
• Certified Case Manager (CCM), Accredited Case Manager (ACM) or RN‑BC in Case Management within two years of hire.

• Organizational, analytical and computer literacy skills.
• Excellent interpersonal, communication, confidentiality, collaboration and negotiation skills.
• Ability to work independently and establish relationships with physicians.
• Knowledge of local community resources, Medicare, Medicaid, commercial payers and reimbursement.
• Computer experience managing multiple open applications; data comprehension, research, analysis and judgment.

Mid‑Senior level

Full‑time

Other

Hospitals and Health Care