Registered Nurse (RN) Case Manager

RN Case ManagerThe RN Case Manager is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to promote timely throughput, safe discharge, and prevent avoidable readmissions. This position integrates national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention; Transition Management promoting appropriate length of stay, readmission prevention, and patient satisfaction; Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care; Compliance with state and federal regulatory requirements, TJC accreditation standards, and Tenet policy; Education provided to physicians, patients, families and caregivers.ResponsibilitiesAccurate medical necessity screening and submission for Physician Advisor reviewIdentifying and referring complex patients to Social Work ServicesCollaborating with physicians, office staff and ancillary departmentsTimely complete and concise documentation in Case Management systemIdentification and documentation of potentially avoidable daysIdentification and reporting over and underutilizationPerforms related duties as requiredQualificationsRequired: Education: Graduate of an accredited school of nursingExperience: 2 years of acute hospital patient care experienceLicensure/Certification: RNMust be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policyActive RN license for state(s) covered.Preferred: Education: Academic degree in nursing (bachelor's or master's)Experience: Acute hospital case management experienceLicensure/Certification: Accredited Case Manager (ACM)About UsJoin our dedicated healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the opportunity to make a meaningful impact in patients' lives while enjoying a supportive work environment that fosters professional growth and work-life balance. Ready to be a vital part of our mission? Apply today and bring your passion for nursing to a place where it truly matters!At Metrowest Medical Center - Consolidated, we understand that our greatest asset is our dedicated team of professionals. That's why we offer more than a job we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:Medical, dental, vision, and life insurance401(k) retirement savings plan with employer matchGenerous paid time offCareer development and continuing education opportunitiesHealth savings accounts, healthcare & dependent flexible spending accountsEmployee Assistance program, Employee discount programVoluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insuranceNote: Eligibility for benefits may vary by location and is determined by employment statusAbout the TeamMetroWest Medical Center has been serving the community since we opened as the first public medical facility in Framingham in 1893. MetroWest Medical Center is comprised of Framingham Union Hospital and Leonard Morse Hospital, a unique behavioral health specialty center located in Natick dedicated to the mental health of our community. At Framingham Union Hospital, youll find comprehensive health care services for the entire family including 24-hour emergency care, advanced cardiac care, high-tech cancer treatments and advanced maternity care including our Special Care Level IIB nursery and high-risk pregnancy care. MetroWest Medical Center was recognized by the Joint Commission with a Gold Seal of Approval, a symbol of quality that reflects our commitment to meeting performance standards and providing safe and effective patient care. Our skilled cardiac team was recognized as one of Healthgrades Americas 100 best hospitals for Coronary Intervention and ranked among the top 5% in the nation for coronary interventional procedures in 2023. At MetroWest Medical Center, you can grow your career skills and be a vital member of our team dedicated to improving the health of our community. Join us!