Care Coordinator, Nurse Case Manager - Care Coordination
At UMass Memorial Health Care, Everyone is a Caregiver regardless of title. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health care system of Central and Western Massachusetts, and a place where we can help you build the career you deserve. We are more than 14,000 employees, working together as one health care system. And everyone, in their own unique way, plays an important part, everyday.
Requisition #: 192567
Title: Coordinator Care
Department: Care Coordination Dept
Shift Length: 10 hours
Location: UMass Memorial Medical Center – University Campus
Responsible for identifying individual patient needs and developing plans of care as well as engaging and integrating appropriate resources for optimal clinical and financial patient outcomes. Responsible for the efficient collection of meaningful clinical and utilization data to effectively support care coordination initiatives.
Massachusetts licensure as a registered nurse and three (3) years clinical experience in discharge planning or case management. Utilization management and third party payer knowledge preferred. The ability to effectively use specialized computer based systems for the gathering, reporting, and analysis of clinical data. Excellent organizational and communications skills required.
- Performs assessment of patient’s physical, functional, and psycho–social needs through the use of screening tools, direct patient and family communication, medical record review, and discussions with other care givers providing services to the patient. Identifies complex patients in need of intensive case management based on established clinical and financial criteria.
- Performs admission and concurrent reviews as assigned. Performs inpatient reviews in accordance with payer requirements utilizing clinical criteria sets. Meets with 3rd party case managers to discuss cases and assures timely communication of relevant clinical information to third party payers as required. Educates practitioners on the level of care and documentation requirements.
- Collaboratively facilitates the care of patients throughout the continuum of care. Works as a team member to support /collaborate with Care Coordination Team for monitoring level of care, and for identification of trends in clinical practices and opportunities for improvement.
- Works with patients and families to establish objectives, goals and an action plan to meet the patient’s individual needs within the indicated level of care. Collaborates with the physicians, other care providers and community resources in the care planning process.
- Contacts third party payer to clarify benefit eligibility, coverage, and available resources for patients. May negotiate conversion of benefits for previously non–covered services. Researches alternate sources of funding for non reimbursed services that are part of the patient’s treatment plan.
Standards of Respect:
We’re striving to make respect a part of everything we do at UMass Memorial – for our patients and for each other. We’re expecting that our new caregivers practice our six Standards of Respect: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player, and Be Kind, to help us make respect a part of how we take care of business everyday.
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