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RN, Hospital Case Manager Full Time

Job ID 85988 Full / Part Time: Full-Time
Location: Baystate Medical Center
Regular/Temporary: Regular

Baystate Health is Seeking a Full Time Inpatient Nurse Case Manager

What You Will Do:

  • Completes full assessment of plan of care to determine if criteria are met to ensure third party reimbursement;
  • Collaborate with the payers through ongoing written and verbal communication concerning a patient's plan of care to optimize the reimbursement potential;
  • Monitor for appropriateness of admission, continued stay, and readiness for discharge based on department defined guidelines and criteria as evidenced by appropriate documentation.
  • Informs the patient and the attending physician when the patient doesn’t meet acute care criteria according to department and InterQual criteria.

What You Will Need:

  • Registered Nurse, licensed in Massachusetts a BSN is required.
  • Minimum 4-5 years clinical nursing experience, hospital
  • Thorough knowledge of Utilization Review concepts, resource management and reimbursement methodologies.
  • InterQual Criteria knowledge is strongly preferred.
  • Excellent interpersonal and strong computer skills in order to interact with all levels of health care providers, support staff, and third party payers.

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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