RN Case Manager for Dual Eligible Special Need Plan (D-SNP)
Mass General Brigham
Summary
The RN Case Manager serves as a core member of the care team by coordinating and supporting healthcare within the facility and coordinating referrals for services outside the clinic. The RN provides outreach and enrollment services to meet eligibility requirements of the program and surrounding counties, and ensures coordination and planning, including community and family support, by focusing on the development and coordination of community service plans and partnering with service providers, families, and patients to create a plan of healthcare.
Job description
Primary Responsibilities
- Conduct client assessments and planning.
- Modify patient treatment plans as indicated by patients' responses and conditions.
- Prepare patient/family for discharge.
- Communicate with third party payers to obtain necessary authorization for reimbursement of services.
- Define care goals of patients by providing education, information, and direction to each individual and family.
- Review cases with medical directors on challenging cases as needed.
- Maintain accurate, detailed reports and records.
Additional Skills and Abilities
- Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
- Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
- Ability to establish strong rapport and relationships with patients and staff.
- Proficient in Microsoft Office and industry related software programs.
- Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
- Ability to maintain client and staff confidentiality.
Schedule and Working Model
- Full-time (40 hours) Monday through Friday, ~8:30am-5pm.
- Hybrid: Approximately 2 days per week in the field and 3 days per week at home, with flexibility as needed.
- On remote workdays, employees must use a stable, secure, and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB-provided equipment.
Requirements
- Associate's Degree Nursing required (Bachelor's Degree Nursing preferred).
- Active and unrestricted Registered Nurse (RN) Licensure for the state of Massachusetts required.
- 2+ years of case management and/or discharge planning required.
- Experience working with complex dually eligible populations required.
- Knowledge of Managed Care preferred.
- Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care preferred.
- Proficient in Microsoft Office and industry related software programs.
Benefits
- Health Insurance
- Career Advancement Opportunities
- Differentials
- Premiums
- Bonuses
- Recognition Programs
Company overview
Mass General Brigham is one of the largest integrated healthcare delivery systems in the United States, formed through the merger of Massachusetts General Hospital and Brigham and Women's Hospital. Based in Boston, Massachusetts, this academic medical center system operates multiple hospitals, specialty facilities, and community health centers throughout New England. The organization is renowned for its world-class patient care, cutting-edge medical research, and comprehensive medical education programs. As a teaching affiliate of Harvard Medical School, Mass General Brigham trains the next generation of healthcare professionals while advancing medical science through groundbreaking research initiatives. The system provides a full continuum of healthcare services, from primary care and preventive medicine to complex specialty treatments and emergency services. With a focus on innovation and patient-centered care, Mass General Brigham consistently ranks among the top hospital systems in the nation for clinical excellence and research output.