Registered Nurse Complex Care BWH

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.