- Salary
- $59k – $142k
- Location
- 45 Francis Street Boston (Surgery Building), United States of America
- Workplace
- Hybrid
- Type
- Full-time
- Department
- Healthcare
- Education
- Master
- Source
- Workday
Description
Site: The Brigham and Women's Hospital, Inc.
The Complex Care Case Manager supports case managers in designated areas with complex patient discharges and is an integral part of the Case Management Department. The role reports to Case management nursing Director, with primary efforts focused on supporting patient care progression initiatives and optimal transitional care planning. The Complex Care Case Manager is responsible for researching resources, identifying, and optimizing complex discharge plans for unique patients and groups of patients who often experience barriers to care progression. The role provides day-to-day support and guidance to the nurse case managers and serves in a consultative role to other interprofessional team members, including nursing leadership, physician leadership, hospital administrators, and external community partners.
Does this position require Patient Care? Yes
Essential Functions: Acts as a case manager expert and mentor, independently identifying and resolving issues that impact the quality, safety, and timeliness of care transitions, and escalates to involved stakeholders as appropriate.
-Co-manages with unit-based case managers complex patient care discharges and collaborates with interprofessional clinical teams both internally (i.e. patient financial services, physical therapy) and externally.
-Through participation in routine huddles, rounds, and service line meetings, identifies potential discharge barrier mitigation strategies to ensure care progression and safe care transitions, maximizing all MGB programs.
-Identifies new internal and external escalation pathways and shares with the case management team, providing valuable resources and updates.
-Responsible for executing, socializing, and enforcing best practices related to case management with case managers and other interprofessional care team colleagues.
-Provides mentorship and guidance to clinical teams and case management as needed on complex care and post-acute discharge.
-Monitors ongoing performance of initiatives, collects data, and develops recommendations/identifies opportunities for performance improvement.
-Analyzes trends in lengths of stay, census, readmissions, non-qualified hospital days, and the impact on continuum-based utilization using high-reliability frameworks.
-Coordinates efforts to optimize hospital days, including ineffective admission determinations, discharge planning, utilization of ancillary services, and timely placement.
-Monitors changes and stays current in evidence-based practices, healthcare regulations, payer requirements, accreditation standards, and industry standards to ensure appropriate changes are incorporated into patient care coordination.Hybrid45 Francis Street40RegularDay (United States of America)2200 The Brigham and Women's Hospital, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Summary:The Complex Care Case Manager supports case managers in designated areas with complex patient discharges and is an integral part of the Case Management Department. The role reports to Case management nursing Director, with primary efforts focused on supporting patient care progression initiatives and optimal transitional care planning. The Complex Care Case Manager is responsible for researching resources, identifying, and optimizing complex discharge plans for unique patients and groups of patients who often experience barriers to care progression. The role provides day-to-day support and guidance to the nurse case managers and serves in a consultative role to other interprofessional team members, including nursing leadership, physician leadership, hospital administrators, and external community partners.
Does this position require Patient Care? Yes
Essential Functions: Acts as a case manager expert and mentor, independently identifying and resolving issues that impact the quality, safety, and timeliness of care transitions, and escalates to involved stakeholders as appropriate.
-Co-manages with unit-based case managers complex patient care discharges and collaborates with interprofessional clinical teams both internally (i.e. patient financial services, physical therapy) and externally.
-Through participation in routine huddles, rounds, and service line meetings, identifies potential discharge barrier mitigation strategies to ensure care progression and safe care transitions, maximizing all MGB programs.
-Identifies new internal and external escalation pathways and shares with the case management team, providing valuable resources and updates.
-Responsible for executing, socializing, and enforcing best practices related to case management with case managers and other interprofessional care team colleagues.
-Provides mentorship and guidance to clinical teams and case management as needed on complex care and post-acute discharge.
-Monitors ongoing performance of initiatives, collects data, and develops recommendations/identifies opportunities for performance improvement.
-Analyzes trends in lengths of stay, census, readmissions, non-qualified hospital days, and the impact on continuum-based utilization using high-reliability frameworks.
-Coordinates efforts to optimize hospital days, including ineffective admission determinations, discharge planning, utilization of ancillary services, and timely placement.
-Monitors changes and stays current in evidence-based practices, healthcare regulations, payer requirements, accreditation standards, and industry standards to ensure appropriate changes are incorporated into patient care coordination.
Qualifications
Education
Bachelor's Degree Nursing required and Master's Degree Nursing preferred
Can this role accept experience in lieu of a degree?
No
Licenses and Credentials
- current RN registration in Massachusetts
Accredited Case Manager - Registered Nurse [ACM-RN] - American Case Management Association (ACMA) preferred - Accredited Case Manager [ACM] - American Case Management Association (ACMA) preferred
- Case Management Administrator-Certified [CMAC] - The Center for Case Management preferred Nursing Case Management [CMGT-BC] - American Nurses Credentialing Center (ANCC) preferred
Experience
- Inpatient case management experience with advanced knowledge around standards of practice and regulatory and payer compliance 5-7 years required
- Extensive experience and knowledge in discharge planning 5-7 years required
- Extensive understanding of post-acute resources 5-7 years required
- Utilization review 5-7 years preferred
Knowledge, Skills and Abilities
- Case Management in acute setting and Utilization Management experience/knowledge.
- Strong assessment and problem-solving skills.
- Strong interpersonal skills.
- Ability to work independently with minimal supervision.
- Goal-oriented and accountable.
- Demonstrated organizational skills.
- Demonstrated ability to work in a complex setting.
- Ability to work in an interdisciplinary team-based environment.
- Strong oral and written communication skills.
- Capacity and willingness to present cases/themes to internal and external stakeholders.
- Computer experience preferred.
Additional Job Details (if applicable)
Shift: 40hr day
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$58,656.00 - $142,448.80/Annual
Grade
98TEMP
EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
Skills
Patient CareCompliance