- M-F
- Facility will not pend license/certs)
RN - Case Manager - Pittsfield, United States - Accede Solutions Inc.
Description
Shift:5-8 Hours- 7:00 AM - 3:30 PMResponsibilities:
The Case Manager is responsible for managing the healthcare needs, facilitation and achievement of quality and cost outcomes of all patients within Berkshire Medical Center, across the continuum.
The case manager is responsible for reviewing the patient at admission, and in some instances prior to admission, and concurrently throughout the hospital stay for the appropriate level of care and utilization of resources.
The case manager will perform transition care planning activities to secure appropriate post hospital care arrangements and will monitor the patient during the course of their hospitalization.
Additional Requirements:
Organizational skills. Proven ability to analyze and present data. Computer literacy. Ability to plan, implements, and evaluate change.
Data management skills preferred
Proven excellent interpersonal and communication skills
Ability to maintain confidentiality
Proven collaboration & negotiation skills with providers, patients, families, insurance organizations and government agencies
Proven ability to work independently
Proven excellent organizational skills
Demonstrated ability to establish and maintain relationships with physicians
Knowledge of local community resources required
Knowledge of Medicare, Medicaid, third party commercial payers and reimbursement required
Computer experience required with proven ability to manage multiple open applications
Skills in data comprehension, research, analysis, interpretation, and judgement necessary to prepare a comprehensive summary report for files, management, legal and/or regulatory agencies upon request
Submission Requirements:
3+ years clinical experience in acute care in areas such as internal medicine, surgery, orthopedics, mother/child, cardiology, and oncology.
3+ years clinical experience in Rehab Setting, Home Health and Long-Term Care would be considered.
Ability to perform a comprehensive admission and discharge risk assessment related to quality, financial, payer benefit allowances and limitations, risk management and patient satisfaction.
CASEMGMT - CCM (Certified Case Manager), or ACM (Accredited Case Manager) or RN-BC (Registered Nurse, Board Certification in Case Management)
Experience specializing in utilization management (levels of care knowledge and demonstrable competence with evidence-based criteria tools), discharge planning to entities throughout a continuum of care, 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
Profile Requirements:
Work History
Skills Checklist (pertinent to position), current to 1 year
1 Supervisory Signed Reference (from within the past two years of employment)
License/Certifications - Must be uploaded with profile (Nursys, BLS, Covid Vaccination proofs (dated on or after 10/3/23) or intent to file exemption form
BLS (AHA)
State License Requirements
Massachusetts
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