Nurse Manager, Case Management

Location: MA - Burlington
Recruiter: This email address is being protected from spambots. You need JavaScript enabled to view it.
Job ID: 8968

Nurse Manager, Case Management

Location: Burlington, MA

  • Creates data priorities and report formats that display critical outcome factors, inclusive of LOS, payer data, referral patterns
  • Provides feedback to the department staff regarding Case Management sensitive data findings.
  • Identifies appropriate staffing levels, assignments, and deployment for the department.
  • Establishes role descriptions and performance criteria for staff members.
  • Identifies organizational needs and concerns in payer-provider contracts and contributes to related negotiations.
  • Establishes effective relationships with individual physicians, physician groups, and physician organizational structures.
  • Establishes processes and policies that adhere to Joint Commission standards as well as CMS Conditions of Participation and other regulations.
  • Collaborates with Compliance to ensure developed processes and policies meet compliance standards.
  • Establishes a Utilization Management Committee, participates in the selection of standing agenda items, and provides reports and data to be reviewed.
  • Develops structures and processes to facilitate participation by physicians, pharmacists, nurses, Social Workers and other health professionals in multidisciplinary care planning, care delivery, and discharge planning.
  • Develops relationships with the organization's accountable care organization as well as with outside preferred providers, SNF's, and Home Health Agencies.
  • Evaluates and optimizes patient satisfaction with discharge planning functions.
  • Directs utilization review activities for the hospital, interfacing with external payers and review companies to determine appropriate medical necessity of admissions and continued hospitalization.
  • Resolves conflicts related to discharge planning with patients/families, external agencies and payers.
  • Facilitates transition of patients/families across the continuum by establishing relationships with appropriate providers and community services.

Minimum Qualifications:

  • 5+ years of accumulated inpatient nursing experience and 2+ years of leadership experience.
  • Knowledge of payer requirements and discharge planning regulations that support the effect development of departmental policies, procedures and standards.
  • Demonstrated ability to: Establish the goals, vision, and overall direction of a department; create and implement departmental standards, systems, staffing plan and processes; analyze issues and create and effective plan to address them; critically and comprehensively evaluate the department's outcomes; identify, collect and analyze data related to the internal and external environment as well as departmental functioning; and, develop and educate staff.
  • Life Support Certification:
  • CCM is a plus.

All interested and qualified Nurses can contact John Baumann at 978-941-4206, or email: This email address is being protected from spambots. You need JavaScript enabled to view it.

All communication will be held in strictest confidence

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