Job Description

Requisition Number: 10421

Location: CHA Somerville Campus 

Work Days: Mon-Fri; 8:00-4:30, rotating weekends and holidays  

Category: Registered Nurse  

Department: Inpatient Case Management SH 

Job Type: Full time  

Work Shift: Day 

Hours/Week: 40.00 

Union Name: MNA Somerville

This position in onsite  in Somerville

Department Description:

Utilization review (UR) in behavioral health that evaluates the medical necessity of service to patients, appropriateness, and effectiveness of healthcare services, ensuring patients receive the right care at the right time. Assessing the medical necessity of services provided to patients to ensure the right LOC. It involves ensuring compliance with clinical guidelines, and determining whether the services align with the patient's needs by conducting concurrent reviews and retrospective reviews with the insurance companies, completing Interquals as required and offering guidance to families regarding insurance as needed. 

Summary:

Under the general supervision of the Director of Care Management, the RN Case Manager provides clinically-based case management to support the delivery of effective and efficient patient care consistent with the Centers for Medicaid and Medicare Conditions of Participation. The RN Case Manager will collaborate with other members of the health care team to identify appropriate utilization of resources and to ensure reimbursement. Utilize criteria to confirm medical necessity for admission and continued stay. With the patient, family and health care team, create a post-acute care plan appropriate to the patient's needs and resources and facilitate this transition in concert with that patient's inpatient and post-acute care teams.  Complete and inform insurances on patient discharge per protocol.

Qualifications/Experience:

Education: Bachelor of Science in Nursing (BSN) degree preferred.

Licensure and Certifications: Current Massachusetts RN license. 

Certification in Case Management preferred. 

American Red Cross (ARC) or American Heart Association (AHA)BLS certification required

Experience: Hospital Care Management Experience strongly preferred. 

Provider Minimum of 5 years of broad clinical experience, predominately in psych nursing. Case Management experience preferred.

In keeping with federal, state and local laws, Cambridge Health Alliance (CHA) policy forbids employees and associates to discriminate against anyone based on race, religion, color, gender, age, marital status, national origin, sexual orientation, gender identity, veteran status, disability or any other characteristic protected by law. We are committed to establishing and maintaining a workplace free of discrimination. We are fully committed to equal employment opportunity. We will not tolerate unlawful discrimination in the recruitment, hiring, termination, promotion, salary treatment or any other condition of employment or career development. Furthermore, we will not tolerate the use of discriminatory slurs, or other remarks, jokes or conduct, that in the judgment of CHA, encourage or permit an offensive or hostile work environment.

 

Cambridge Health Alliance brings Care to the People - including your neighbors, friends and family. Our local hospitals and care centers serve our vibrant, diverse communities, and play an integral role in improving health. As passionate advocates for the underserved, we actively partner with our communities to take on challenging public health issues, and conduct important research to help reduce barriers to care. We believe that everyone deserves access to high quality, convenient health care. This is why our employees believe in where they work and why many build long, rewarding careers at CHA.

Healthcare is changing rapidly. CHA has a strategic plan that charts a proactive course for our future. It is built on a vision of equity and excellence for everyone, every time. It also recognizes that our workforce is our most valuable asset and prioritizes competitive salaries, benefits and professional development opportunities for employees. The strategic plan is changing the way we provide care and improving the health and experience of our patients; we are looking for smart, committed, compassionate people who want to be part of making our vision of better health and equity a reality.

At CHA, you can believe in where you work and go home every day knowing you made a difference. Join our team and help us bring Care to the People.

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