RN Care Management - Medical
Company: Tufts Medicine
Location: Boston
Posted on: April 17, 2024
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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, Cambridge , RN Care Management - Medical, Healthcare , Boston, Massachusetts
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