Boston Medical Center RN Transition Care Supervisor-Utilization Mgt-Robinson Building-40 Hour Days in Boston, Massachusetts

RN Transition Care Supervisor-Utilization Mgt-Robinson Building-40 Hour Days

Job ID 5087614 Date posted 07/12/2017

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Boston Medical Center (BMC) is more than a hospital. It´s a network of support and care that touches the lives of hundreds of thousands of people in need each year. It is the largest and busiest provider of trauma and emergency services in New England. Emphasizing community-based care, BMC is committed to providing consistently excellent and accessible health services to all—and is the largest safety-net hospital in New England. The hospital is also the primary teaching affiliate of the nationally ranked Boston University School of Medicine (BUSM) and a founding partner of Boston HealthNet – an integrated health care delivery systems that includes many community health centers. BMC provides a full range of pediatric and adult care services, from primary to family medicine to advanced specialty care.

BMC is also committed to our employees, who are a very important piece to who we are. We pride ourselves in providing equal employment opportunity and non-discrimination for all employees and qualified applicants without regard to a person's race, color, gender, age, religion, national origin, ancestry, disability, veteran status, genetic information, sexual orientation or any characteristic protected under applicable law. BMC will make reasonable accommodations for qualified individuals with known disabilities, in accordance with applicable law.

Transition Care Supervisor

40 Hours Days

The Transition Care Supervisor will direct, supervise and review the activities and work of staff related to the Super Utilizer Program. The Supervisor will also work in collaboration and in continuous partnership with the ‘high- risk” patient and their family/caregiver(s), clinic/hospital/specialty providers and staff, and the community resources in a team approach to: Promote timely access to appropriate care; reduce emergency department utilization and hospital readmissions; create and promote adherence to a care plan, developed in coordination with the health care team; increase patients’ ability for self-management and shared decision making; and connect patients to relevant community resources, with the goal of enhancing patient health and well-being, increasing patient satisfaction and reducing health care costs

Graduate of an accredited BS program in Nursing preferred.

Licensed to practice professional nursing as a Registered Nurse in the Commonwealth of Massachusetts.

A minimum of 3-5 years’ clinical experience required and 1-3 years of acute, Inpatient Care Management experience required.

A minimum of 2 years of previous experience involving judgment and decision making, preferably in a utilization management/case management position

Coordination and Service Delivery – The care manager will understand confidentiality and the legal and ethical issues pertaining to it; understand medical terminology, how to obtain an accurate history; establish treatment goals; establish working relationships with referral sources; develop treatment plans.

Physical and Psychological Factors – The care manager will understand methods for assessing an individual’s level of physical/mental impairment; understand the physical and psychological characteristics of illness; be able to assist individuals with the development of short- and long-term health goals.

Benefit Systems and Cost Benefit Analysis – The care manager will understand the requirements for prior approval by payer; be able to evaluate the quality of necessary medical services; be able to acquire and analyze the cost of care; understand the various health care delivery systems and payer plan contracts; be able to demonstrate cost savings.

Case Management Concepts – The care manager will understand case management philosophy and principles; apply problem solving techniques to the care management process; document care management services; understand liability issues for care management activities.

Community Resources – The care manager will understand how to access and evaluate the available resources to meet a client’s needs; will be able to develop new resources.

  • Extensive background and knowledge of current medical/surgical patterns of practice.

  • Medical terminology and standard medical abbreviations.

  • Managed care concepts, the various health care delivery systems

  • Methods for assessing an individual are level of physical/mental impairment, understanding of the physical and psychological characteristics of illness, and understanding of expected treatment.

  • Confidentiality issues and the legal and ethical issues pertaining to them.

  • ICD-9 and CPT nomenclature and the ability to interpret and convert this information, as applicable.

  • Knowledge of benefits and various plan contracts, eligibility issues and requirements.

  • Role and functional responsibilities of case management professional; case management program philosophy and purpose within Managed Care Program

  • Excellent interpersonal, verbal and written communication and negotiations skills

  • Current working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement.

  • Strong analytical, data management and PC skills

  • Understanding of pre-acute and post-acute venues of care and post-acute community resources.

  • Experience working with the high utilizer population