Job Title: Nurse Case Manager
Organization: Wentworth-Douglass Hospital (WDH)
Location: WDH Main Hospital, 789 Central Ave, Dover, NH 03820
Schedule: Full-time
Standard Hours: 40
Shift: Day Job
Employee Status: Regular
Recruiting Department: WDH Care Coordination
Job Posting Date: Aug 29, 2024
About Wentworth-Douglass Hospital: Wentworth-Douglass Hospital, an affiliate of Mass General Brigham, is committed to supporting patient care, research, teaching, and service to the community. We value diversity and inclusivity as we aim to reflect the patients we serve.
Responsibilities:
- Facilitates coordination of care for patients along the healthcare continuum:
- Meets directly with the patient/family to assess needs and develop an individualized plan in collaboration with the provider.
- Refers appropriate cases for social work interventions.
- Collaborates/communicates with external case managers.
- Initiates and facilitates referrals for home healthcare, hospice, DME and pharmacy.
- Facilitates transfer to other facilities as appropriate.
- Documents relevant discharge planning information in the medical record according to department standards.
Demonstrates professionalism with managed care entities and processes:
- Keeps informed of changes in contractual relationships for all payer systems.
- Coordinates/ performs all follow-up activities related to Medicare, other third-party payers, and hospital-negotiated contracts.
- Informs ED Director, CFO/VP Finance and/or other management team members of situations which require notification or administrative action.
Demonstrates excellence in leadership skills and professional performance:
- Maintains close communication with ED Director/coordinator regarding utilization, quality of care, risk, and infection control issues.
- Participates in departmental and hospital committees, ad hoc committees, task forces and work groups.
Collects data pertinent to care management, utilization management, and performance improvement:
- Documents clinical pathway variances and outcomes which relate to area of direct responsibility in MIDAS.
Evaluates the provision of care and the appropriate utilization of resources:
- Reviews medical records for appropriateness of admission and/or continued stay using established criteria.
- Communicates utilization issues to the appropriate individuals.
Minimum Requirements:
- 2 or more years in Med/Surg, Long Term Acute Care or a similar field.
- Current and valid RN license.
- Strong analytical, data management, and PC skills.
- Strong clinical assessment skills and knowledge of medical standards of care.
- Excellent interpersonal communication and negotiation skills.
- Knowledge of third-party payer systems and levels of care.
- Strong organizational and time management skills.
EEO Statement: Wentworth-Douglass Hospital is an Equal Opportunity Employer, ensuring all qualified applicants receive consideration for employment without regard to protected status.
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