Job Profile Summary

This role focuses on providing professional and nonprofessional nursing care services in accordance with physician orders. In addition, this role focuses on performing the following Care Manager related duties: Works as part of a multidisciplinary team to coordinate their patient's care in an effort to improve patient outcomes and create efficiencies. A professional individual contributor role that may direct the work of other lower level professionals or manage processes and programs.   The majority of time is spent overseeing the design, implementation or delivery of processes, programs and policies using specialized knowledge and skills typically acquired through advanced education. A senior level role that requires advanced knowledge of job area typically obtained through advanced education and work experience.  Typically responsible for: managing projects / processes, working independently with limited supervision, coaching and reviewing the work of lower level professionals, resolving difficult and sometimes complex problems.

Job Overview

The RN Case Manager manages a designated caseload to coordinate and complete timely assessment, planning, implementation and evaluation of discharge plans and care transitions across the continuum of care.

Job Description

Minimum Qualifications:
1. Massachusetts RN Licensure.

2. 3 Years of RN Experience.

3. Current Basic Life Support (BLS) Certification.

Preferred Qualifications:

1. Bachelor of Science in Nursing (BSN).

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list.  Other duties and responsibilities may be assigned.

1. Interviews and collects specific information and data from patients and families, contributes to the identification of specific physical, emotional, educational and cultural needs of those patients.

2. Maintains documentation of assessment findings, discharge arrangements, and actions taken according to departmental guidelines.

4. Completes a discharge assessment, to include appropriate documentation, according to established policies and procedures.

5. Identifies barriers to efficient cost-effective provision of care.

6. Identifies expected outcomes individualized to the patient. 

Collaborates with physician, healthcare team, and the patient/family in decision making and planning of care during hospitalization and in anticipation of discharge.

7. Implements the plan of care to achieve the identified expected outcomes for the patient.

8. Utilizes community and other resources and systems to implement the plan facilitating referrals when appropriate.

9. Provides education for the patients and families and documents according to policy.

10. Coordinates activities related to financial/insurance issues, including providing clinical updates to insurance companies.

11. Coordinates insurance appeals related to discharges and adhering to policies and procedures of Medicare and Medicaid. 

12. Assists in achieving unit quality scores which meet or exceed hospital established targets for nurse sensitive quality indicators as appropriate for the unit.

Physical Requirements: 

1. Ability to sit for extended periods of time.

2. Prolonged standing and walking.

3. Occasional twisting, bending, reaching, pushing/pulling, sitting, kneeling, and squatting.

Skills & Abilities:

1. Ability to plan, implement and evaluate data and individual patient needs after emergency department visits.

2. Ability to effectively communicate with patients, families, physicians, and healthcare team.

Ability to analyze, evaluate multiple solutions, and solve complex problems using well developed critical & analytical thinking skills.

3. Knowledge of and application of the nursing process.

4. Excellent time management skills needed to prioritize competing priorities.

5. Requires the ability to work independently and establish an effective working relationship with healthcare providers in physician’s offices, community agencies, hospitals and other healthcare facilities.

6. Maintains working knowledge of specific benefits and reimbursement guidelines, the discharge planning process and applicable federal, state and local regulations.

Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts. Comprised of Tufts Medical Center, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, Care at Home - an expansive home care network, and large integrated physician network. We are an equal opportunity employer and value diversity and inclusion at Tufts Medicine. Tufts Medicine does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided 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. Please contact us to request accommodation by emailing us at careers@tuftsmedicine.org.