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Case Manager Baystate Wing Hospital

Job ID 85293 Full / Part Time: Full-Time
Location: Palmer, Massachusetts
Regular/Temporary: Regular

Baystate Wing Hospital

After years of partnering, Wing Hospital has joined Baystate Health. 

Wing and Baystate share deep, committed roots in western Massachusetts and our high quality of care has earned the trust and support of patients and neighbors. We take our responsibility to our community seriously while expecting the best from ourselves. We deliver, because we share a simple passion: to provide the best, most appropriate, and compassionate care. 

Our dedication to continuous improvement and modernization helps set Baystate Wing Hospital apart. Over 75% of our employees are trained in Lean Six Sigma, a leading tool for process improvement, resulting in exceptional patient care at an extraordinary value and an extremely engaged workforce. 

Baystate Wing Hospital’s 74-bed main facility in Palmer, MA provides the region with a broad range of emergency, medical, surgical, and psychiatric clinical care. Our five medical centers—Belchertown, Ludlow, Monson, Palmer, and Wilbraham—offer extensive outpatient services. Baystate Wing also includes the Griswold Behavioral Health Center and the Wing Visiting Nurse Association & Hospice. 

Baystate Health and Wing Hospital: better together, and together, delivering a higher state of caring.

What you will do:

  • Communicates appropriately and clearly to department director, physicians, staff, CNO, administrative team and billing department.
  • Works with denial management to provide applicable information to the team to assist in the appeals process.
  • Reviews utilization management activities for occurrences and trends that affect the quality, cost effectiveness and delivery of services. Assures that the outcome of review is appropriately maintained.
  • Collects and prepares the documentation for the resolution of appeals and grievances.
  • Consults other departments, as appropriate, to collaborate in patient care and performance improvement activities. Collaborates with other departments to identify operational problems and develop solutions/resolution.

What you will need:

  • Current MA Registered Nurse License
  • Bachelor's degree in Nursing
  • Current CPR 
  • 1 or more years utilization management experience in the managed care environment preferred 
  • 1 or more years acute hospital, home health, hospice, inpatient mental facility experience required
  • Ability to effectively communicate in English, both verbally and in writing
  • Additional languages preferred.
  • Strong written and verbal skills.
  • Advanced computer knowledge.
  • Current clinical knowledge.
  • Understanding of healthcare/HMO industry

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

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