RN Care Coordinator; Case Manager BWH

RN Care Coordinator (Case Manager) – Brigham & Women's Hospital

Location:

45 Francis Street, Boston, MA

Shift: 40 hours variable rotating

Employment type:

Regular, Full-time

Job Summary

The RN Care Coordinator manages a caseload of patients, ensuring care that supports desired clinical and financial outcomes. The role leverages patient assessment, interdisciplinary care guidelines, payer regulations, and response to therapies to navigate the episode of illness from pre‑admission to post‑discharge. The RNCC participates in ongoing evaluation of practice patterns, supports quality and cost improvement initiatives, and mobilizes resources to maximize efficiency of care delivery.

Principal Duties and Responsibilities

• Care Facilitation: coordinates and assures implementation of the plan of care using case‑management principles.
• Within 24‑48 hours of admission: conducts patient/family interviews and reviews with physicians to develop a provisional treatment program and tentative discharge date.
• Daily: reviews the treatment plan with physicians, nurses, and patient families to ensure interdisciplinary communication.
• Participates in nursing staff and physician care rounds to contribute to the plan of care and monitor patient progress.
• Collaborates with other departments to expedite the sequencing and scheduling of interventions, consults, treatments, and ancillary services.
• Provides daily continuity with patients to ensure discharge‑related needs are met.
• Incorporates utilization‑management principles and payer contract knowledge into patient care plans, informing physicians and nurses of implications.
• Presents inpatient alternatives to the attending physician and the patient/family based on clinical and insurance factors.
• Seeks assistance or consultation from Care Coordination leadership for outlier or potential resource‑intensive patients.
• Interacts with internal and external health‑care providers to facilitate inpatient and post‑discharge services.
• Contributes to development, implementation, and monitoring of practice guidelines.
• Identifies learning needs for attending, resident, and nursing staff related to case management and collaborates with leaders to develop educational plans.
• Discharge Planning:
  • Assesses continuing care needs with other caregivers.
  • Coordinates interdisciplinary meetings with patients and families regarding discharge needs and plans.
  • Ensures patient education consistent with the discharge plan has occurred.
  • Identifies service, treatment, and funding options for post‑hospital care.
  • Promotes interdisciplinary communication and documentation to finalize discharge plans the day prior to discharge.
  • Follows up with patients/families after discharge to monitor outcomes.
  • Initiates contact with home health agencies and extended‑care facilities to ensure prompt transition of care.
• Utilization Management:
  • Identifies patients likely to have unmet insurance or resource needs and communicates with the care team and relevant departments.
  • Communicates with third‑party payers regarding patient progress.
  • Issues Medicare notices of non‑coverage and documents the process.
  • Uses Inter Qual criteria to monitor and report variances from the established treatment plan, including admission appropriateness, prolonged stay, delays, and discharge plan compliance.
  • Conducts documented utilization reviews for insurers or intermediaries.
  • Identifies SNF and AND days for Medicare and Medicaid patients.
  • Initiates actions to reduce inappropriate hospital admissions and days, addressing system delays.
  • Works with payers and physicians to resolve level‑of‑care concerns affecting claims and reimbursement.
  • Contributes to utilization and practice improvement by reviewing reports and providing feedback on utilization trends and payer issues.
  • Serves as the primary patient information source to third‑party payers.

Qualifications

• Graduate of an approved school of nursing with current registration in Massachusetts;
  Bachelor of Science in Nursing required for newly licensed nurses and external candidates.
• 1+ years of acute‑care experience required.
• 1 year of case‑management experience required; inpatient acute hospital case‑management experience preferred.
• Skills…