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Description
POSITION SUMMARY
Utilizing a collaborative process, the care manager will assess, plan, implement, monitor, and evaluate the options and services required to meet an individual's health needs, using communication and available resources to promote quality, cost-effective outcomes. The care manager helps identify appropriate providers and facilities throughout the continuum of services while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the patient and the reimbursement source. This care manager is dedicated to handle the increased volume and to support the overall care management process and the department.
Position: Registered Nurse - ED Care Manager
Department: ED Case Management
Schedule: Part-Time
JOB REQUIREMENTS
EDUCATION:
Graduate of an accredited BS Program in Nursing
CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:
Licensed to practice as a Registered Nurse in the commonwealth of Massachusetts
CCM or related certification attained within 24 months from the hire date is preferred
EXPERIENCE:
3-5 years of diversified clinical experience is required
ED experience preferred
A minimum of 2 years of previous experience involving judgment and decision making, preferably in a utilization management/case management position
KNOWLEDGE AND SKILLS:
- Extensive background and knowledge of current medical/surgical patterns of practice.
- Medical terminology and standard medical abbreviations.
- Managed care concepts, the various health care delivery systems
- Methods for assessing an individual are level of physical/mental impairment, understanding of the physical and psychological characteristics of illness, and understanding of expected treatment.
- Confidentiality issues and the legal and ethical issues pertaining to them.
- ICD-9 and CPT nomenclature and the ability to interpret and convert this information, as applicable.
- Knowledge of benefits and various plan contracts, eligibility issues and requirements.
- Role and functional responsibilities of case management professional; case management program philosophy and purpose within Managed Care Program
- Excellent interpersonal, verbal and written communication and negotiations skills
- Strong analytical, data management and PC skills
Every third weekend required.
Equal Opportunity Employer/Disabled/Veterans
