Baystate Health, a nationally recognized leader in healthcare quality and safety, and home to Baystate Franklin Medical Center is looking for a Per Diem Registered Nurse (RN), Case Manager to join our Hospital Case Management team in Greenfield, MA !Resume Required with ApplicationAt Baystate Health, RN means more. It stands for our deep respect for nursing professional practice that is essential to our mission. It also stands for Baystate’s many opportunities for growth and learning in the region’s only academic medical center and within our community hospitals, and it stands for our commitment to taking care of all those in the community who need us.Baystate Franklin Medical Center (BFMC) is an 89-bed community hospital in Greenfield, MA. Rooted in a rich tradition of service and accountability to the people of Franklin County, North Quabbin, and surrounding communities, BFMC services include emergency, surgery, cancer, heart and vascular, obstetrics, and more.
More than 200 physicians on active and courtesy staff
More than 24,000 Emergency Department visits annually
More than 400 babies delivered each year in The Birthplace – a progressive, midwife-driven service.
Training site for the Family Medicine residency, and for residents in emergency medicine, surgery, and obstetrics programs based at Baystate Medical Center
Franklin Medical Center joined Baystate Health in 1986
Rooted in a rich tradition of 125 years of service and accountability, our highly skilled team is committed to advancing care with our state-of-the art facilities and technology. Baystate Franklin houses a $26 million surgical center and the talented surgical teams of the Baystate Health network. Our spacious pre-surgery, recovery, and family waiting areas offer privacy and comfort with natural light, healing gardens, and other amenities. Our multidisciplinary approach gives you access to specialists from across the Baystate Health system, offering comprehensive and collaborative medical treatments close to home.SCHEDULE:
Per Diem
MINIMUM QUALIFICATIONS:
MA Registered Nurse License
American Heart Association BLS CPR
Minimum 3 years acute care clinical nursing experience
Case Management experience
LOCATION :
Baystate Franklin Medical Center
Greenfield, MA
Onsite parking
THE ADVANTAGES OF WORKING WITH BAYSTATE!
Excellent Compensation High-quality, low-cost medical, dental and vision insurance
Generous PTO – up to 25 days in the first year, with scheduled earned increases
Continuing education support and reimbursement
First Time Home Buyers Financial Packages
Farm Share Memberships
403b retirement company match & annual company contribution increase based on years of service.
Free money coach advice from a certified professional
Wellbeing programs that include but are not limited to mental, physical, and financial health.
Pet, home, auto and personal insurance
Life insurance
Reimbursement for a variety of wellbeing activities, included but limited to gym membership and equipment, personal trainer, massage and so much more!
Wellbeing programs that include but are not limited to mental, physical, and financial health.
Onsite parking
Baystate Health, western Massachusetts’ only academic center and tertiary care provider has a long and proud tradition of continuous learning and improvement. We educate and train hundreds of healthcare workers every year and advance knowledge about new approaches to care. At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. We are committed to increasing diverse representation across our organization. Together our inspired and compassionate teams manage the whole health needs of all communities in need.We strive to be the place where we can help you build the career you deserve – apply today – YOU belong at Baystate!For more information, please visit us online at: baystatehealthjobs.com or interact with us socially at facebook.com/BaystateCareers or on Twitter @BaystateCareersAll correspondence can be directed to:Cole Courtemanche, Healthcare [email protected]:The Utilization Management Specialist (UMS)/Hospital Case Manager (HCM) is a Registered Nurse (RN) responsible for the coordination of care, quality and financial outcomes for a designated population of patients. The UMS/HCM coordinates use of Baystate Health (BH) resources to assure that patients are provided optimal quality of care and service, researches and responds to all medical and behavioral health appeal inquiries and requests, in accordance with contractual, account, policy and accreditation requirements, conducts admission and concurrent reviews to obtain certification, facilitates and coordinates with internal and external customers in a proactive manner to bring review/appeal to satisfactory resolution, collaborates with payers through ongoing written and verbal communication to optimize the reimbursement potential for Baystate Franklin Medical Center, coordinates resolution of patient complaints regarding questionable and/or inappropriate charges, adheres to system and department compliance policies and any applicable laws and regulations and provides high quality customer service.The Hospital Case Manager participates in the implementation of a patient-centered plan of care. Coordinates input from all health care professionals, conducts assessments of patient and family needs and facilitates and documents the discharge plan, assuring continuity of care. Identifies and contributes to modifications in nurse and physician practice patterns, utilizing case management tools, to achieve quality of care, patient satisfaction, and appropriate use of resources, in alignment with medical management initiatives and product line goals. Evaluates appropriateness of admissions and continued stay using approved criteria. Collaborates with payers through ongoing written and verbal communication to optimize the reimbursement potential for Baystate Franklin Medical Center. Adhere to system and department compliance policies, and any applicable laws and regulations. Provides case management coverage 7 days a week.Job Responsibilities:1) Uses Case Management skills to ensure quality patient centered care is achieved. Assists and supports development of case management program. Utilizes effective communication with peers, patients and families. Performs daily review of cases and makes appropriate recommendations to the care team for practice guideline utilization, LOS, and quality of care. Recognizes the case manager role in assessing, facilitating, collaborating and coordinating patient services through the continuum of care. Effectively collaborates with others on the healthcare team to resolve patient care issues. Applies utilization criteria correctly and responsibly to best portray the process of care delivery at BFMC. Identifies appropriateness of admission and concurrent days of stay. Provides verbal and written notices of non-coverage to patients and/or their representatives, in accordance with departmental policies and third-party regulations.2) Performs Utilization Management ActivitiesInvestigates issue in question and communicates resolution and/or information to Patient Financial Services and/or other departments. Coordinates communication efforts between Health Information Management, physicians and other members of the health care team to ensure optimal documentation necessary for accurate hospital coding and billing. Refers appropriate cases to Manager and/or physician advisor for further review. Uses Outlook, CIS, SMS, MIDAS+ as a tool for multidisciplinary communication. Demonstrates the ability to use Outlook, CIS, SMS, MIDAS+ and Oracle information systems to retrieve and document clinical information accurately to track appeals cases and billing complaints.3) Conduct admission reviews for private insurers in order to obtain admission certification; conducts admission reviews for medical necessity and appropriate level of care. Collaborate with physician advisor when needed. Review medical record though manual and/or electronic systems using criteria established by the hospital and clinical input from physicians, care managers and interdisciplinary team. Act as a resource to the Care Management staff, physicians, and nurses with current knowledge of HINN, Medicare Important Message, ABN, and Condition Code 44. Deliver HINN, MIM, ABN to patients/families as required. Coordinate and complete continued stay reviews using established criteria and communicates with payers as appropriate, using established processes. Collaborate with physicians, care managers, social work and makes recommendation regarding medical necessity for admission, continued stay, or alternative treatment facilities or agencies.4) Provides post-acute hospital care planning/discharge facilitation when needed. Proactively works with the healthcare team to identify those patients who will need post-acute care following discharge. Serves as an educator and mentor to others on the healthcare team on the process of post-acute care planning. Involves patients/families in the discharge planning process to facilitate a clear understanding by all parties. Monitors each patient's discharge plan of care for variance and makes appropriate recommendations and revises the plan as necessary. Assures that interventions are in alignment with medical management initiatives. Provides appropriate financial information to patients and/or families including scope of reimbursement sources. Follows all state and federal guidelines in regard to patient rights in planning for their post-acute needs.5) Contributes to Day-To-Day Functioning of the DepartmentDemonstrates the ability to recognize and act on priorities promptly. Willingly adjusts schedule to needs of department and co-workers. Smoothly adjusts to temporary increases in workload. Assists in maintaining Utilization Review/Appeals and Denials documents to reflect current workflow. Responds to questions and inquiries from public and employees in a courteous and pleasant manner. Identifies areas for improvement in departmental and hospital functions and communicates suggestions to manager. Manages special projects as required by manager.6) Assumes Responsibility for Own Professional GrowthAttends educational programs to maintain current knowledge in utilization management, denial management, with specific emphasis on own areas of responsibility. Attends educational programs to maintain knowledge of current clinical management of patient problems on assigned clinical areas. Attends regularly scheduled departmental and revenue operation meetings. Establishes annual goals for professional growth and seeks opportunities that lead to the accomplishment of these goals7) Participates in Quality Improvement of the DepartmentParticipates in and supports Quality Improvement initiatives of the department. Assess patient information for quality, infection control, risk management issues and makes appropriate referrals.Required Work Experience:1) Minimum 3 years acute care clinical nursing experience-Case Management experiencePreferred Work Experience:1) Experience in utilization review processSkills and Competencies:1) Ability to organize and prioritize workload in order to meet deadlines, must possess excellent interpersonal skills, have full working knowledge and experience in health care delivery, management, regulations and health insurance models and have strong database management, verbal and written communication skillsYou Belong At BaystateAt Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.DIVERSE TEAMS. DIVERSE PATIENTS. DIVERSE LOCATIONS.Education:Certifications:Registered Nurse - OtherEqual Employment Opportunity EmployerBaystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.Ab out Baystate HealthBaystate Health (BH) is one of New England’s leading and largest integrated health care organizations, serving a population of nearly one million people throughout western New England. With roots dating back to the founding of Springfield City Hospital in 1873, Baystate Health has been providing high-quality and compassionate health care in western Massachusetts for more than 145 years. With more than 12,000 employees, a medical staff of nearly 3,100 physicians, and a net patient service revenue of more than $1.4 billion, the ever-growing health system includes five Massachusetts hospitals and the Baystate Mary Lane Outpatient Center in Ware:
Baystate Medical Center in Springfield
Baystate Children’s Hospital (located at Baystate Medical Center)
Baystate Franklin Medical Center in Greenfield
Baystate Wing Hospital in Palmer
Baystate Noble Hospital in Westfield