RN Care Management - Medical

Company: Tufts Medicine
Location: Boston
Posted on: April 17, 2024

Job Description:

We're saving lives, building careers, and reimagining healthcare. This role focuses on providing professional and nonprofessional nursing care services in accordance with physician orders . Assesses, plans, implements, and evaluates the care needs of a designated group of patients or provides nursing care and identified clinical support tasks within the scope of practice for achievement of the patient's plan of care as directed . Provides professional nursing care to patients. Requires a nursing license . A professional individual contributor role that may direct the work of other lower level professionals or manage processes and programs . The majority of time is spent overseeing the design, implementation or delivery of processes, programs and policies using specialized knowledge and skills typically acquired through advanced education . A senior level role that requires advanced knowledge of job area typically obtained through advanced education and work experience . Typically responsible for: managing projects / processes, working independently with limited supervision, coaching and reviewing the work of lower level professionals, resolving difficult and sometimes complex problems. -
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This position is responsible and accountable for the management of care for an assigned patient population by unit, across the continuum of care . The Case Manager works to achieve daily clinical, quality and cost outcomes by providing well-coordinated experiences for patients/families through the synchronization of care activities of multiple disciplines and negotiating with third party payors. ensuring and facilitating the achievement of quality and clinical customer service; addressing and resolving patterns or issues that have a negative quality-cost impact; Associate ' s Degree in Nursing . -
Three (3) years of Case Management experience . -
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Bachelor ' s Degree in Nursing . -
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Complete s assessments on all new admissions to determine the need for all appropriate Case Management services. -
Conducts daily multidisciplinary rounds on assigned units, reviews patient's plan of care and coordinates including: Modification of plan to meet continuing care needs of the patient; and Monitors ongoing process of gathering adequate information from all relevant sources to insure operation of plan . -
Discusses estimated length of stay, treatment and discharge plan with the attending physician and healthcare team by establishing strong, collaborative relationships with physicians and team members and discusses the appropriateness of resource utilization , consults and treatment plan . -
Ensures that the interdisciplinary care plan and discharge plan are consistent with the patient's clinical course, covered services and continuing care needs. -
Identifies patients and families with complex psychosocial, financial and legal discharge planning needs and refers them to social work. -
Incorporates knowledge of clinical expertise , quality initiatives, insurance and finance into decision-making and problem solving of individual patient cases and across case type during care management activities. -
Fosters and maintains a positive working relationship with referral agencies and liaisons to enhance patient flow. -
Collects and reports on quality projects, i.e. Risk management ; and Quality improvement . -
D ocuments patient/family progress towards discharge and all critical events and information associated with the hospital stay in SoftMed . -
S upports the EMR and all computer programs, including SoftMed and Soarian. -
Ensures that documentation in the medical record supports the admission and continued stay, in order to reduce denial rate. -
Documents care management activities in the initial assessment and as the patient progresses towards discharge and at discharge. -
Interacts with Admitting, Financial Counselors, Insurance Case Managers, Finance and Screeners as appropriate . -
Maintains clinical competency and current knowledge of regulatory and payor requirements to perform job responsibilities. -
Completes roles and functions related to discharge planning/coordination including case identification, high risk screening, assessment of patient and resources, goal setting, implementing, maintaining and evaluating process. Coordinate s all discharge activities and initiates all appropriate referrals to continuum of care agencies in a timely manner. -
Facilitates patient transfer from one level of care to the next. -
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Regularly exposed to the risk of blood borne diseases. -
Maintains clinical competency and current knowledge of regulatory and payer requirements to perform job responsibilities -
Possesses and applies the skills and knowledge necessary to provide care to patients throughout the life span, with consideration of aging processes, human development stages and cultural patterns in each step of the care process. -
Incorporates the highest standard of professional, clinical, legal and ethical practice into their own daily practice ( i.e. patient's rights, maintains confidentiality, role model to nursing). -

Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts. Comprised of Tufts Medical Center, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, Care at Home - an expansive home care network, and large integrated physician network. We are an equal opportunity employer and value diversity and inclusion at Tufts Medicine. Tufts Medicine does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.

Keywords: Tufts Medicine, Malden , RN Care Management - Medical, Healthcare , Boston, Massachusetts