The Managed Care Nurse is responsible for care coordination at times of transitions of care, for high-risk/high utilization patients, and maintaining continuity of care for certain diagnostic exams.
The Managed Care Nurse is an integral member of the Patient Care Team which includes physicians, nurse practitioners, team nurses, behavioral health professionals and administrated staff. The role of the Managed Care Nurse is to work, at the highest level of function allowable, as part of the Patient Care Team to provide for optimal outcomes and enhance the care provided to patients.
The Managed Care Nurse must demonstrate excellent organizational, communication, spread sheet and database skills. Must be comfortable with use of technology, including electronic health record and database management. Working as an effective member of a team as well as working independently is required. Graduation from an accredited School of Nursing and unencumbered Massachusetts RN license is required. At least 5 years nursing experience with at least 2 of those years of experience in an in-patient setting. Bachelors of nursing degree is preferred.
Representative Job Duties
Emergency Department Visits
- Review BMC report for admissions/complex complaints.
- Review ED notifications from other facilities for admissions/complex complaints.
- Obtain ED notes for these cases.
- Complex ED complaints: Initiate Care Management Note, route to Team RN for follow up.
- Admissions: Initiate CM note. Add information to excel sheet.
- Review excel sheet daily.
- Review Care Everywhere and NEMC Soarian for updated information pertaining to admission. Document in SBCHC Care Management note.
- For complex/high-risk patients contact admitting facility Case Managers to aid in discharge planning.
- Obtain discharge summary.
- Summarize hospital course in Care Management note.
- Update SBCHC med list and problem list.
- Call patient : Document SBCHC Care Management Post Discharge note.
- Update excel sheet.
- Manage referrals.
- Document in Care Management note.
- Maintain excel sheet.
- Provide patient support.
- Follow-up on imaging results, office visits.
- Provide education and support to patients and Providers.
- Provide patient care/case management as requested.
- Work to develop collaborative relationships with community agencies.
Complex Care Management
- Attend High Risk Care Management meetings as required.
- Document care plan, patient interactions and interventions in EHR.
- Perform evaluations and/or follow up with patients as required.
Attends all required training.
Other duties as assigned.
Competitive benefits package. Generous tuition assistance after 1 year of service.
Please send resumes to:
Email | firstname.lastname@example.org