Summary

The Hospital Case Manager is a registered nurse responsible for the coordination of clinical care, quality, and financial outcomes of a designated population of patients. The Hospital Case Manager is responsible for overseeing an efficient plan that will ensure continuity and effective community or post acute reentry. The Hospital Case Manager leads the interdisciplinary team in developing complex discharge plans.

Responsibilities:

• Facilitates patients care plan as called for in the plan of care

• Leads daily patient care huddles with nursing to direct timely progress along the continuum

• Works cooperatively as a leading member of the health care team to insure appropriate use of hospital resources, patient satisfaction, and achievement of quality of care. Manages input from all health care professionals and conducts assessments to determine patients health care and transitional needs. Su

• Evaluates and ensures appropriateness of admissions and continued stay using evidence based criteria

• Collaborates and manages outcomes with the payers through ongoing written and verbal communications to appropriate parties

• Leads discussions with Physician advisors and MD's about safe plan for transitions

• Leads the team to ensure appropriate utilization of patient resources and directs care to other settings when appropriate

• Collaborates with community case managers and other health care advisors to ensure a smooth and safe continuum of care plan

• Conducts extensive assessments and implements interventions for patients at risk for readmissions

• Manages concurrent denials and works with physicians to overturn for appropriate reimbursement

Required Work Experience:

• BSN Required

• 3-5 years clinical Nursing experience

• Hospital Case Management, Care Coordination experience strongly preferred

Skills and Competencies:

• Requires a working knowledge of community resources and Utilization/Quality Review standards and activities conducted by third party payers

• Ability to organize and prioritize workload in order to meet deadlines

• Must possess excellent interpersonal skills in order to interact with all levels of health care providers, support staff, and third party payers where appropriate

• Excellent computer skills

• Must possess excellent interpersonal skills in order to interact with all levels of health care providers, support staff, and third party payers where appropriate

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

Ab out Baystate Health

Baystate Health (BH) is one of New England’s leading and largest integrated health care organizations, serving a population of nearly one million people throughout western New England. With roots dating back to the founding of Springfield City Hospital in 1873, Baystate Health has been providing high-quality and compassionate health care in western Massachusetts for more than 145 years. With more than 12,000 employees, a medical staff of nearly 3,100 physicians, and a net patient service revenue of more than $1.4 billion, the ever-growing health system includes five Massachusetts hospitals and the Baystate Mary Lane Outpatient Center in Ware:

• Baystate Medical Center in Springfield

• Baystate Children’s Hospital (located at Baystate Medical Center)

• Baystate Franklin Medical Center in Greenfield

• Baystate Wing Hospital in Palmer

• Baystate Noble Hospital in Westfield