Nurse Case Manager - Senior Care Options - Worcester

apartment Fallon Health location_onWorcester, MA 01608, US

Overview

About us:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief summary of purpose:

The Nurse Case Manager (NCM) is an integral part on an interdisciplinary team focused on care coordination, care management and improving access to and quality of care for Fallon members. NCM seeks to establish telephonic and/or face to face relationships with the member/caregiver(s) to better ensure ongoing service provision and care coordination, consistent with the member specific care plan developed by the NCM and Care Team. Responsibilities may include conducting in home face to face visits for member identified as needing face to face visit interaction and assessments with the goal to coordinate and facilitate services to meet member needs according to benefit structures and available community resources. The NCM may conduct assessments and may determine the number of hours’ members require for MassHealth programs such as the personal care attendant program, adult foster care, group adult foster care, and other programs per product benefits and guidelines. The NCM may utilize an ACD line to support department and incoming/outgoing calls with the goal of first call resolution with each interaction.

Responsibilities

Note: Job Responsibilities may vary depending upon the member’s Fallon Health Product

Member Assessment, Education, and Advocacy

Telephonically assesses and case manages a member panel
May conduct in home face to face visits for onboarding new enrollees and reassessing members, utilizing a variety of interviewing techniques, including motivational interviewing, and employs culturally sensitive strategies to assess a Member’s clinical/functional status to identify ongoing special conditions and develops and implements an individualized, coordinated care plan, in collaboration with the member, the Clinical Integration team, and Primary Care Providers, Specialist and other community partners, to ensure a cost effective quality outcome
Performs medication reconciliations
Performs Care Transitions Assessments – per Program and product line processes
Utilizing clinical judgment and nursing assessment skills, may complete NaviCare Program Assessment Tools and Minimum Data Set Home Care (MDS HC) Form when a member’s medical/functional status changes that warrants a change in rating category to ensure members are in the correct State defined rating category
Maintains up to date knowledge of Program and product line benefits, Plan Evidence of Coverage details, and department policies and processes and follows policies and processes as outlined to be able to provide education to members and providers, performing a member advocacy and education role including but not limited to member rights
Serves as an advocate for members to ensure they receive Fallon Health benefits as appropriate and if member needs are identified but not covered by Fallon Health, works with community agencies to facilitate access to programs such as community transportation, food programs, and other services available through senior centers and other external partners
Follows department and regulatory standards to authorize and coordinate healthcare services ensuring timeliness in compliance with documented care plan goals and objectives
Assesses the Member’s knowledge about the management of current disease processes and medication regimen, provides teaching to increase Member/caregiver knowledge, and works with the members to assist with learning how to self- manage his or her health needs, social needs or behavioral health needs
Collaborates with appropriate team members to ensure health education/disease management information is provided as identified
Collaborates with the interdisciplinary team in identifying and addressing high risk members
Educate members on preventative screenings and other health care procedures such as vaccines, screenings according to established protocols and program processes such initiatives involving Key Metrics outreach
Ensures members/PRAs participate in the development and approval of their care plans in conjunction with the interdisciplinary primary care team
Strictly observes HIPAA regulations and the Fallon Health Policies regarding confidentiality of member information
Supports Quality and Ad-Hoc campaigns

Care Coordination and Collaboration

Provides culturally appropriate care coordination, i.e. works with interpreters, provides communication approved documents in the appropriate language, and demonstrates culturally appropriate behavior when working with members, family, caregivers, and/or authorized representatives
With member/authorized representative(s) collaboration develops member centered care plans by identifying member care needs while completing program assessments and working with the Navigator to ensure the member approves their care plan
Manages NaviCare members in conjunction with the Navigator, Behavioral Health Case Manager, Aging Service Access Point Geriatric Support Service Coordinator, contracted Primary Care Providers and others involved/authorized in the member’s care
Manages ACO members in conjunction with the Navigator, Social Care Managers, ACO Partners, Community Partners, Behavioral Health Partners and others involved/authorized in the member’s care
Monitors progression of member goals and care plan goals, provides feedback and works collaboratively with care team members and work effectively in a team model approach to coordinate a continuum of care consistent with the Member’s health care goals and needs
Works collaboratively with Fallon Health Pharmacist, referring members in need of medication review based upon Program process
Develops and fosters relationships with members, family, caregivers, PRAs, vendors and providers to ensure good collaboration and coordination by streamlining the focus of the Member’s healthcare needs utilizing the most optimal treatment approach, promoting timely provision of care, enhancing quality of life, and promoting cost-effectiveness of care
Actively participates in clinical rounds

Provider Partnerships and Collaboration

May attend in person care plan meetings with providers and office staff and may lead care plan review with providers and care team as applicable.
Demonstrates positive customer service actions and takes responsibility to ensure member and provider requests and needs are met

Regulatory Requirements – Actions and Oversight

Completes Program Assessments, Notes, Screenings, and Care Plans in the Centralized Enrollee Record according to product regulatory requirements and Program policies and processes
Knowledge of and compliance with HEDIS and Medicare 5 Star measure processes, performing member education, outreach, and actions in conjunction with the Navigator and other members of the Clinical Integration and Partner Teams
Performs other responsibilities as assigned by the Manager/designee
Supports department colleagues, covering and assuming changes in assignment as assigned by Manager/designee

Qualifications

Education:

Graduate from an accredited school of nursing mandatory and a Bachelors (or advanced) degree in nursing or a health care related field preferred.

License:

Active, unrestricted license as a Registered Nurse in Massachusetts

Certification:

Certification in Case Management strongly desired

Other:

Satisfactory Criminal Offender Record Information (CORI) results and reliable transportation

Experience:

• 1+ years of clinical experience as a Registered Nurse managing chronically ill members or experience in a coordinated care program required• Understanding of Hospitalization experiences and the impacts and needs after facility discharge required• Experience working face to face with members and providers preferred• Experience with telephonic interviewing skills and working with a diverse population, that may also be Non-English speaking, required• Home Health Care experience preferred• Effective case management and care coordination skills and the ability to assess a member’s activities of daily function and independent activities of daily function and the ability to develop and implement a care plan that meets the member’s need working in partnership with a care team preferred• Familiarity with NCQA case management requirements preferred

Performance Requirements including but not limited to:• Excellent communication and interpersonal skills with members and providers via telephone and in person• Exceptional customer service skills and willingness to assist ensuring timely resolution• Excellent organizational skills and ability to multi-task• Appreciation and adherence to policy and process requirements• Independent learning skills and success with various learning methodologies including but not limited to: self-study, mentoring, classroom, and group education• Working with an interdisciplinary care team as a partner demonstrating respect and value for all roles and is a positive contributor within job role scope and duties• Willingness to learn insurance regulatory and accreditation requirements• Knowledgeable about software systems including but not limited to Microsoft Office Products – Excel, Outlook, and Word • Familiar with Excel spreadsheets to manage work and exposure and familiarity with pivot tables• Accurate and timely data entry• Effective case management and care coordination skills and the ability to assess a member’s activities of daily function and independent activities of daily function and the ability to develop and implement a care plan that meets the member’s need • Knowledge about community resources, levels of care, criteria for levels of care and the ability to appropriately develop and implement a care plan following regulatory guidelines and level of care criteria • Ability to effectively respond and adapt to changing business needs and be an innovative and creative problem solver

Competencies:

Demonstrates commitment to the Fallon Health Mission, Values, and Vision
Specific competencies essential to this position:
- Problem Solving
  - Asks good questions
  - Critical thinking skills, looks beyond the obvious
- Adaptability
  - Handles day-to-day work challenges confidently
  - Willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change
  - Demonstrates flexibility
- Written Communication
  - Is able to write clearly and succinctly in a variety of communication settings and styles

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $88,000 - $95,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Share this job

Related Jobs

Other

Registered Nurse, Watkins 2, Per Diem, Evenings/Nights, Weekends

apartment Heywood Healthcare location_onGardner, MA

Overview You Matter Here! Heywood Healthcare values our employees! We offer competitive wages, great benefits and generous earned time off. Come work where you will matter! Hours: Per Diem, Evenings/Nights, Weekends Hourly Rate: $37.26 - $76.63 Responsibilities Essential Functions Assesses (and reassesses), plans, implements, and evaluates nursing interventions/plans of care/patient goals. Provides patient care based on standards of care, standards of practice, protocols, and established policies and procedures. Respects each patient as an individual; provides care that fosters the patient’s sense of dignity and positive self-regard. Provides patient/family teaching based on identified learning needs, readiness to learn, and barriers to learning. Collaboratively plans and prepares patient/family for discharge incorporating support systems/resources as necessary. Appropriately delegates and supervises nursing interventions performed by others. Appropriately prioritizes patient care (e.g. seeks assistance as needed from appropriate resources, reassigns personnel as necessary, recognizes need for emergency intervention, etc.). Provides thorough, timely, and accurate documentation of all pertinent data, therapeutic interventions and patient responses according to established standards. Provides timely and thorough report on assigned patients to other health care team members to ensure integration of services and continuity of patient care. Promotes learning for colleagues and self (e.g. functions as preceptor, instructor, trainer, attends professional development programs, etc.). Proactively identifies risk to patient safety and identifies opportunities to reduce medical/health care errors (i.e. appropriate reporting of errors/incidents). Identifies ethical issues in care and develops plan to address. Safely administers medications and intravenous therapy in accordance with physician’s orders, protocols, policies and procedures. Assesses patient pain level upon admission and as necessary, depending upon diagnosis utilizing the numerical pain scale. Reassesses effectiveness of pain control and notifies physicians as needed, as well as, documents assessment and patients’ response to medication. Responsible for obtaining supporting information and completing required documentation related to medication reconciliation for use by the Attending provider. Interprets and documents patient cardiac rate, rhythm and configuration (PR ST segment) and initiates appropriate treatment plan based on provider orders. Provides ongoing assessment and teaching to the surgical patient/family, utilizing current standards and protocols. Recognizes normal and deviant progress patterns and reports problems or concerns to physician in a timely manner. Utilizes pain management devices and other techniques to ensure proper pain relief. Sets up, maintains and troubleshoots other equipment related to the surgical patient such as; traction/orthopedic equipment/devices, feeding pumps, chest tubes and drains, etc. Statement of Other Duties This document describes the major duties and responsibilities for this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described. Functional Demands Physical Requirements Exerts 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects. Frequently reaches (extending hands and arms in any direction), handles (seizing, holding, grasping, turning, or working with hands), and feels (perceiving attributes of items such as size, shape, temperature, or texture by means of fingertips). Occasionally stoops (bending the body downward and forward by bending the spine at the waist), and kneels (bending the legs at knee to come to rest on knee or knees). Organizational Expectations Behavioral Attributes The following behavioral attributes are required: achievement motivation, concern for order, flexibility, initiative, self-confidence, customer service oriented, interpersonal effectiveness, teamwork, analytical thinking and information seeking. Qualifications Job Requirements Minimum Education Graduate of an accredited school of nursing Minimum Work Experience 1 year Med/Surg experience preferred 1 year Telemetry experience preferred 1 yr Pediatrics experience preferred Minimum Licenses and Certifications Current MA RN license ACLS upon hire OR must hold an active BLS card and obtain AHA ACLS within 60 days of hire PALS preferred Required Skills Demonstrates mature professional behaviors, (i.e. tact, empathy and diplomacy) Promotes a positive working environment

OB/GYN

Other

Registered Nurse, Obstetrics, Per Diem, All shifts, Occasional weekend coverage

apartment Heywood Healthcare location_onGardner, MA

Overview You Matter Here! Heywood Healthcare values our employees! We offer competitive wages, great benefits and generous earned time off. Come work where you will matter! Hours: Per Diem, All shifts, Occasional weekend coverage Hourly Rate: $37.26 - $76.63 Responsibilities Essential Functions Assesses (and reassesses), plans, implements, and evaluates nursing interventions/plans of care/patient goals. Provides patient care based on standards of care, standards of practice, protocols, and established policies and procedures. Respects each patient as an individual; provides care that fosters the patient’s sense of dignity and positive self-regard. Provides patient/family teaching based on identified learning needs, readiness to learn, and barriers to learning. Collaboratively plans and prepares patient/family for discharge incorporating support systems/resources as necessary. Appropriately delegates and supervises nursing interventions performed by others. Appropriately prioritizes patient care (e.g. seeks assistance as needed from appropriate resources, reassigns personnel as necessary, recognizes need for emergency intervention, etc.). Provides thorough, timely, and accurate documentation of all pertinent data, therapeutic interventions and patient responses according to established standards. Provides timely and thorough report on assigned patients to other health care team members to ensure integration of services and continuity of patient care. Promotes learning for colleagues and self (e.g. functions as preceptor, instructor, trainer, attends professional development programs, etc.). Proactively identifies risk to patient safety and identifies opportunities to reduce medical/health care errors (i.e. appropriate reporting of errors/incidents). Identifies ethical issues in care and develops plan to address. Safely administers medications and intravenous therapy in accordance with physician’s orders, protocols, policies and procedures. Assesses patient pain level upon admission and as necessary, depending upon diagnosis utilizing the numerical pain scale. Reassesses effectiveness of pain control and notifies physicians as needed, as well as, documents assessment and patient’s response to medication. Provides appropriate care to the postpartum and gynecological patient. Safely cares for surgical and postpartum patients, recognizes complications and initiates appropriate nursing interventions in collaboration with physicians. Provides appropriate information and education to patients and families based upon individual needs so they may effectively care for themselves during hospitalization and following discharge. Ensures new mothers and families have the basic understanding of newborn care and resources available after discharge. Demonstrates knowledge of medications and the correct administration based on age of patient and their clinical condition. Demonstrates proper technique for assessing fundal height, and fundal massage. Demonstrates ability to assess lochia, perineum, breast, bowel, bladder and emotional status. Responsible for obtaining supporting information and completing required documentation related to medication reconciliation for use by the Attending MD. Provides assessment and planning for individualized patient care in collaboration with physicians and other disciplines. Assesses the normal stages of labor, delivery and recovery, as well as, identifies any deviation of the normal pattern and progress and takes appropriate action. Utilizes fetal monitoring equipment, external and internal (FSE and IUPC), and correctly interprets FHR patterns and initiates appropriate nursing interventions as needed. Assists in the stabilizing of high-risk patients and accompanies them during transfer to a level two or tertiary care center as appropriate. Communicates with physicians about changes in patients’ clinical condition. Safely administers and demonstrates knowledge of medications used in labor and delivery. Implements appropriate procedure for labor checks, inductions, augmentations, NSTs, external cephalic versions and epidurals. Able to articulate care for patients with fetal demise based on perinatal loss protocol and appropriately provides care when applicable. Performs a systematic and thorough newborn assessment based upon knowledge of expected adaptation to extrauterine life so that deviation can be recognized. Communicates appropriately and clearly with physicians concerning any changes in newborn condition and/or abnormal diagnostic test results. Performs neonatal resuscitation, assisting physician as necessary. Identifies newborn problems, initiates appropriate nursing interventions, and assists in the stabilization of a critical newborn. Provides care and support to mother in her chosen method of infant feeding so that learning is enhanced. Demonstrates to new mothers appropriate feeding techniques using literature and teaching videos as appropriate (frequency and symptoms of adequate intake). Provides teaching to new mother on newborn care based upon individual patient/family needs so that new mother is able to care for newborn upon discharge. Utilizes informative discussions, videos, handouts, one on ones, teaching class to individualize newborn teaching. Utilizes appropriate nursing interventions for infants experiencing difficulty adjusting to extrauterine life. Sets up phototherapy, monitors vital signs, including pulse oximetry, according to policy and procedure; demonstrates proper technique for administering CPAP via mask or RAM cannula Demonstrates knowledge of medications and their correct administration based on age of newborn and his/her clinical condition. Statement of Other Duties This document describes the major duties and responsibilities for this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described. Qualifications Job Requirements Minimum Education Graduate of an accredited school of nursing Minimum Work Experience Minimum one year med/surg experience required Maternity experience preferred Minimum Licenses and Certifications Current MA license IV competent, ACLS upon hire OR must hold an active BLS card and obtain AHA ACLS within 60 days of hire NRP certified or ability to obtain NRP certification within 90 days of hire. For nurses working L&D, must have/complete AWHONN’s Introduction to Fetal Monitoring and also must have/attend AWHONN’s Intermediate Fetal Heart Monitoring within 1 year Required Skills Demonstrates mature professional behaviors, (i.e. tact, empathy and diplomacy). Promotes a positive working environment.

OB/GYN

Other

Registered Nurse, Obstetrics, Per Diem, All Shifts, Minimum requirement is 16 hours per month

apartment Heywood Healthcare location_onGardner, MA

Overview You Matter Here! Heywood Healthcare values our employees! We offer competitive wages, great benefits and generous earned time off. Come work where you will matter! Hours: Per Diem, All Shifts, Minimum requirement is 16 hours per month Hourly Rate: $37.26 - $76.63 Responsibilities Essential Functions Assesses (and reassesses), plans, implements, and evaluates nursing interventions/plans of care/patient goals. Provides patient care based on standards of care, standards of practice, protocols, and established policies and procedures. Respects each patient as an individual; provides care that fosters the patient’s sense of dignity and positive self-regard. Provides patient/family teaching based on identified learning needs, readiness to learn, and barriers to learning. Collaboratively plans and prepares patient/family for discharge incorporating support systems/resources as necessary. Appropriately delegates and supervises nursing interventions performed by others. Appropriately prioritizes patient care (e.g. seeks assistance as needed from appropriate resources, reassigns personnel as necessary, recognizes need for emergency intervention, etc.). Provides thorough, timely, and accurate documentation of all pertinent data, therapeutic interventions and patient responses according to established standards. Provides timely and thorough report on assigned patients to other health care team members to ensure integration of services and continuity of patient care. Promotes learning for colleagues and self (e.g. functions as preceptor, instructor, trainer, attends professional development programs, etc.). Proactively identifies risk to patient safety and identifies opportunities to reduce medical/health care errors (i.e. appropriate reporting of errors/incidents). Identifies ethical issues in care and develops plan to address. Safely administers medications and intravenous therapy in accordance with physician’s orders, protocols, policies and procedures. Assesses patient pain level upon admission and as necessary, depending upon diagnosis utilizing the numerical pain scale. Reassesses effectiveness of pain control and notifies physicians as needed, as well as, documents assessment and patient’s response to medication. Provides appropriate care to the postpartum and gynecological patient. Safely cares for surgical and postpartum patients, recognizes complications and initiates appropriate nursing interventions in collaboration with physicians. Provides appropriate information and education to patients and families based upon individual needs so they may effectively care for themselves during hospitalization and following discharge. Ensures new mothers and families have the basic understanding of newborn care and resources available after discharge. Demonstrates knowledge of medications and the correct administration based on age of patient and their clinical condition. Demonstrates proper technique for assessing fundal height, and fundal massage. Demonstrates ability to assess lochia, perineum, breast, bowel, bladder and emotional status. Responsible for obtaining supporting information and completing required documentation related to medication reconciliation for use by the Attending MD. Provides assessment and planning for individualized patient care in collaboration with physicians and other disciplines. Assesses the normal stages of labor, delivery and recovery, as well as, identifies any deviation of the normal pattern and progress and takes appropriate action. Utilizes fetal monitoring equipment, external and internal (FSE and IUPC), and correctly interprets FHR patterns and initiates appropriate nursing interventions as needed. Assists in the stabilizing of high-risk patients and accompanies them during transfer to a level two or tertiary care center as appropriate. Communicates with physicians about changes in patients’ clinical condition. Safely administers and demonstrates knowledge of medications used in labor and delivery. Implements appropriate procedure for labor checks, inductions, augmentations, NSTs, external cephalic versions and epidurals. Able to articulate care for patients with fetal demise based on perinatal loss protocol and appropriately provides care when applicable. Performs a systematic and thorough newborn assessment based upon knowledge of expected adaptation to extrauterine life so that deviation can be recognized. Communicates appropriately and clearly with physicians concerning any changes in newborn condition and/or abnormal diagnostic test results. Performs neonatal resuscitation, assisting physician as necessary. Identifies newborn problems, initiates appropriate nursing interventions, and assists in the stabilization of a critical newborn. Provides care and support to mother in her chosen method of infant feeding so that learning is enhanced. Demonstrates to new mothers appropriate feeding techniques using literature and teaching videos as appropriate (frequency and symptoms of adequate intake). Provides teaching to new mother on newborn care based upon individual patient/family needs so that new mother is able to care for newborn upon discharge. Utilizes informative discussions, videos, handouts, one on ones, teaching class to individualize newborn teaching. Utilizes appropriate nursing interventions for infants experiencing difficulty adjusting to extrauterine life. Sets up phototherapy, monitors vital signs, including pulse oximetry, according to policy and procedure; demonstrates proper technique for administering CPAP via mask or RAM cannula Demonstrates knowledge of medications and their correct administration based on age of newborn and his/her clinical condition. Statement of Other Duties This document describes the major duties and responsibilities for this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described. Qualifications Job Requirements Minimum Education Graduate of an accredited school of nursing Minimum Work Experience Minimum one year med/surg experience required Maternity experience preferred Minimum Licenses and Certifications Current MA license IV competent, ACLS upon hire OR must hold an active BLS card and obtain AHA ACLS within 60 days of hire NRP certified or ability to obtain NRP certification within 90 days of hire. For nurses working L&D, must have/complete AWHONN’s Introduction to Fetal Monitoring and also must have/attend AWHONN’s Intermediate Fetal Heart Monitoring within 1 year Required Skills Demonstrates mature professional behaviors, (i.e. tact, empathy and diplomacy). Promotes a positive working environment.

Psych

Other

Registered Nurse, Geriatric Psychiatry Unit, Per Diem

apartment Heywood Healthcare location_onGardner, MA

Overview You Matter Here! Heywood Healthcare values our employees! We offer competitive wages, great benefits and generous earned time off. Come work where you will matter! Hours: Per Diem Hourly Rate: $37.26 - $76.63 Job Summary: Under the supervision of the Nurse Manager or designee, the Registered Nurse functions as a professional participant in the health care team providing direct and indirect patient care to patients, families, and significant others utilizing the nursing process in accordance with the philosophy and goals and objectives of Nursing Service. Responsibilities Essential Functions Assesses (and reassesses), plans, implements, and evaluates nursing interventions/plans of care/patient goals. Provides patient care based on standards of care, standards of practice, protocols, and established policies and procedures. Provides patient care based on standards of care, standards of practice, protocols, and established policies and procedures. Respects each patient as an individual; provides care that fosters the patient’s sense of dignity and positive self-regard. Provides patient/family teaching based on identified learning needs, readiness to learn, and barriers to learning. Collaboratively plans and prepares patient/family for discharge incorporating support systems/resources as necessary. Appropriately delegates and supervises nursing interventions performed by others. Appropriately delegates and supervises nursing interventions performed by others. Appropriately prioritizes patient care (e.g. seeks assistance as needed from appropriate resources, reassigns personnel as necessary, recognizes need for emergency intervention, etc.). Provides thorough, timely, and accurate documentation of all pertinent data, therapeutic interventions and patient responses according to established standards. Provides timely and thorough report on assigned patients to other health care team members to ensure integration of services and continuity of patient care. Promotes learning for colleagues and self (e.g. functions as preceptor, instructor, trainer, attends professional development programs, etc.). Proactively identifies risk to patient safety and identifies opportunities to reduce medical/health care errors (i.e. appropriate reporting of errors/incidents). Identifies ethical issues in care and develops plan to address Responsible for obtaining supporting information and completing required documentation related to medication reconciliation for use by the Attending MD. Safely administers medications and intravenous therapy in accordance with physician’s orders, protocols, policies and procedures. Assesses patient pain level upon admission and as necessary, depending upon diagnosis utilizing the numerical pain scale. Reassesses effectiveness of pain control and notifies physicians as needed, as well as, documents assessment and patients’ response to medication. Performs assessment of psychiatric and physical needs on each patient upon admission and uses data collected to create and/or revise nursing plan of care. Performs pre-admission screenings and appropriate insurance procedures. Assesses the unit milieu and makes decisions to maintain a safe environment for all patients, staff and visitors. Understands the indication, therapeutic effect, dosage, and side effects of psychoactive medications on the geriatric patient. De-escalates volatile situations and/or individuals using non-violent techniques. Creates and updates the Master Treatment Plan, coordinating with hospital and community providers and significant others. Participates actively in multi-disciplinary treatment team in planning, coordinating, implementing and evaluating patient care. Meets with families and significant others and residential providers in planning appropriate disposition and discharge. Statement of Other Duties This document describes the major duties and responsibilities for this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described. Functional Demands Physical Requirements: Exerts 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects. Frequently reaches (extending hands and arms in any direction), handles (seizing, holding, grasping, turning, or working with hands), and feels (perceiving attributes of items such as size, shape, temperature, or texture by means of fingertips). Occasionally stoops (bending the body downward and forward by bending the spine at the waist), and kneels (bending the legs at knee to come to rest on knee or knees). Organizational Expectations Behavioral Attributes: The following behavioral attributes are required: achievement motivation, concern for order, flexibility, initiative, self-confidence, customer service oriented, interpersonal effectiveness, teamwork, analytical thinking and information seeking. Qualifications Job Requirements Minimum Education Associates degree in nursing required. Bachelors preferred. Minimum Licenses and Certifications Registered Nurses, Current MA License AHA CPR required Minimum Work Experience Experience handling crisis and emergency situations Required Skills Good interpersonal skills. Demonstrates mature professional behaviors, (i.e. tact, empathy, diplomacy). Promotes a positive working environment. Physical and mental health to meet the demands of the position.

Other

RN Care Coordinator, Case Management, Per Diem, Days and Weekends, Varied schedule, Monday-Sunday

apartment Heywood Healthcare location_onGardner, MA

Overview You Matter Here! Heywood Healthcare values our employees! We offer competitive wages, great benefits and generous earned time off. Come work where you will matter! Hours: Per Diem, Days and Weekends, Varied schedule, Monday-Sunday Responsibilities Essential Functions: Utilization Management- Utilization Review and Care Transitions & Coordination Providing clinical information to payers, monitoring length of stay, seeking necessary care authorizations and utilizing the InterQual Program; appealing denials as indicated within a timely fashion. Reviews all new admissions and Observation patients within 24 hours of admission against High Risk Screening Criteria and documents outcome within the UM EMR. Completes assessments on re-admissions within 30 days including reasoning for re-admission documents findings and provides data to the department for stratifying data. Follows-up on lack of documentation for medical necessity, supporting documentation with discipline identified. Trackand trend opportunities for improvement resulting in late Insurance Reviews, longer lengths of stay; including educating providers to Interqual Criteria used for determining Admission or Observation status. Completes utilization reviews daily and/or as required by insurer, (concurrent and retro) for medical and/or psychiatric appropriateness according to Hospital's approved criteria timely and efficiently. Assesses, intervenes, evaluates and determines level of care to establish accurate admission and/or observation status; demonstrates basic knowledge of DRG reimbursement, evidenced by standardized measures for length of stay and acuity level status designation. Demonstrates clinical expertise specific to the issuance of ABN/HINN notice to patients and/or legal significant other and care progression. Keeping physician and team informed of status change and documenting status. Provides education and information to patient, family and care providers as it pertains to continuing care, care management, LOS, re-hospitalization and assure understanding of disease management Multidisciplinary Team Rounds-participates in discharge planning rounds daily. Works collaboratively with multidisciplinary team to determine each patient's needs concurrently including post-acute care when needed; addresses LOS issues, appropriate leveling of patient status; addressespotential needs, resources, referrals for other disciplines etc. Quality & Statistical Data: Reviews medical record for abnormal findings,complications, delays and deviations from expected clinical outcomes reports such to Provider and/or Director to maintain an efficient, cost effective episode of care for each patient and documents intervention provided. Acquires knowledge to keep up with changes in technology and regulations. Utilizes knowledge to redesign systems for improving performance. Continuously prioritizes projects, activities, and tasks to ensure deadlines and customer needs are met. Assists with preparation of reports/statistics as it pertains to staff specific workflow. Denials/Appeal Process: Completes assessment of denial within 1 week providing supporting documentation with outcome of review; documents intervention in the UR EMR section. Prepare written appeal letters, termination letters, discharge notices, MOON and IMs when appropriate as per regulatory standards and department policies. Report any variances, trends to director. Submits denials/appeals when completed to the department secretary for processing. Discharge Planning:Communication: builds rapport and responds to needs of physician, reviewers for managed care plans, healthcare team members, 3rd party payers, outside reviewers and vendors to enhance internal and external customer service satisfaction. Responsible for completing nursing sections of the SNF Level of Care forms for Mass Health patients in need of care SNF placement, timely and efficiently and other forms assisting in transition of care as identified and collaborates with the social worker. In the event of an emergency, Care Coordinator may complete the form in full and process it to help expedite discharge planning process and length of stay. The Discharge Planning Process:Completes discharge planning assessments timely, efficiently and completely following regulatory standards and departmental policies assuring appropriate patient flow. Appropriately levels patient for home discharge with or without services or to another type of facility such as a SNF, Acute Rehab etc. Develops coordinates and implements discharge plan on cases assigned with patient and/or family/so caregiver. Identifying patient preference and selection choice for HHA/SNF placements having patient preference form checked off and signed/dates by patient and/or so. When plan is in place, notify provider establish and determine anticipated readiness for discharge, keeping patient/family/so informed and documenting such in the EMR. Closes case out using appropriate forms for transition of care communication timely and efficiently. The Care Coordinator collaborates with the team to assist the Multidisciplinary Team in providing discharge planning activities to assist in expediting a patient’s discharge as part of the care transitions process. It is the expectation that the Care Coordinator remains current and proficient in the discharge planning process in the event coverage is needed. Performs any and all other duties as assigned by director and/or designee. Statement of Other Duties: This document describes the major duties and responsibilities for this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described. Functional Demands Physical Requirements: Exerts 20 to 50 pounds of force occasionally, and/or up to 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects. Frequently reaches (extending hands and arms in any direction), handles (seizing, holding, grasping, turning, or working with hands), and feels (perceiving attributes of items such as size, shape, temperature or texture by means of fingertips). Occasionally stoops (bending the body downward and forward by bending the spine at the waist), and kneels (bending the legs at knee to come to rest on knee or knees). Organizational Expectations Behavioral Attributes: The following behavioral attributes are required: achievement motivation, flexibility, concern for order, initiative, self-confidence, self control, customer service orientation, interpersonal effectiveness, teamwork and information seeking. Qualifications Job Requirements Minimum Education BSN preferred Minimum Work Experience Previous UR/QA experienced required 2 years of healthcare experience within the Acute Care, SNF, HHA, Behavioral Health and/or Insurance Industry preferred Minimum License and Certifications Current Massachusetts Registered Nurse License Required Skills Interqual experience or equivalent preferred Meditech Expanse experience preferred Proficient computer skills required Must have effective written, verbal and interpersonal communication skills Excellent critical thinking Ability to multitask and flexibility essential Discharge planning experience as it pertains to the care transitions, referral process, patient preference/choice services, patient & family satisfaction, post discharge follow-up etc.