Location: Winchester, MA
Job ID: 159070-1A
Date Posted: Dec 5, 2019
Welcome to Winchester Hospital, part of Beth Israel Lahey Health. Winchester Hospital was the first hospital in Massachusetts to earn Magnet recognition, the American Nurses Association’s highest honor for nursing excellence, three times. It has since received the recognition a fourth time. As the northwest suburban Boston area’s leading provider of comprehensive health care services, the 229-bed facility provides care in general, bariatric and vascular surgery, orthopedics, pediatrics, cardiology, pulmonary medicine, oncology, gastroenterology, rehabilitation, radiation oncology, pain management, obstetrics/gynecology and a Level IIB Special Care Nursery.
About the Job
Contributes to the Hospital’s mission by providing our patients with a safe plan of care for discharge. This professional licensed position will have an impact on finance and growth by classifying patients’ status appropriately and maintaining a length of stay within budget. They will impact the patient experience and quality of care by daily rounding and working with the patient/family to establish the best plan of care for discharge.
Hired Prior to 10/1/13: Graduate of a state approved and/or accredited RN program.
Hired On or After 10/1/13: Bachelors’ degree in Nursing (BSN) or obtain BSN within 5 years of hire
BSN upon hire
· At least five (5) years of clinical experience as a Registered Nurse
· Previous Case Management experience
· For safety and quality reasons, must be able to read, write and communicate effectively in English with patients, visitors, vendors, and fellow members of the hospital team.
· Computer skills
· InterQual Criteria
· Current license to practice professional nursing from MA Board of Registration
· Case Management certification
LIFE SUPPORT CERTIFICATION REQUIRED N/A
POPULATION SPECIFIC REQUIREMENTS
Neonate, Infant, Children, Adolescent, Adult, and Geriatric
OTHER JOB REQUIREMENTS:
Professional Commitment Requirements: Keep abreast of developments in the field and/or licensure through continuing education, participation in professional organizations or a combination of both.
On-call: Off-shift coverage rotation expected
Schedule requirements: Holiday rotation and occasional weekend coverage required
Travel requirements: N/A
· Reports to the Director of Case Management
· Not responsible for supervising the work of others
As part of the Case Management team, this position:
· Utilizes the case management process to provide quality and safe patient care by identifying the specific needs of the patient and developing the plan of care for discharge with the patient.
· Establishes a therapeutic relationship with the patient, the patient's family and significant others by involving them in each step of the care coordination process and accommodates factors that may influence the plan of discharge.
· Collaborates with the multidisciplinary healthcare team regarding the patient’s plan of care to promote the best possible outcomes and patient/family experience upon discharge.
· Addresses the patient’s physical, emotional, cultural, and spiritual needs.
· Performs all required documentation accurately, legibly and timely.
· Appropriately follows the chain of command and adheres to hospital policies and procedures.
· Greets patients. Rounds on patients daily to educate and inform them of their plan of care.
· To assess the daily case management workflow and optimize the team’s efficiency, gathers census information, reviews admissions, reconciles admissions, transfers and discharges against census and conducts hand-offs regarding patients when appropriate.
· Reviews discharges to verify the required insurance approvals have been received.
· Collaborates with the patient, patient’s family, insurance companies and the multidisciplinary team to determine and coordinate the patient’s next level of care.
· Patient care rounds with multi-disciplinary team to review the plan of care.
· Reviews patient’s charts, conducts utilization reviews, ensures the physician’s order is appropriate for the level of care the patient meets, applies InterQual criteria to determine the level of care, medical necessity, and coverage of hospitalization.
· Initiates the appropriate termination of benefits notice if the patient does not meet the hospital level of care criteria. As appropriate, refers cases to physician utilization review vendor to establish observations vs. in-patient status. Completes a high risk assessment on any patient who meets the high risk criteria.
· Documents and develops a plan of care in preparation for discharge.
· Collaborates with other healthcare facilities and external vendors to assist patients and patient families in setting up services to transition safely upon discharge to the next level of care.
· Contacts insurance companies to obtain authorizations for hospital stays and levels of care upon discharge.
All departments except Emergency Department:
· For Medicare and Medicare Advantage patients, issues the “Important Message” explaining the discharge appeal process.
· Manages case management functions for the Medicare-specific population.
Full time, 40 hours.
Beth Israel Lahey Health is an integrated system providing patients with better care wherever they are. Care informed by world-class research and education. We are doctors and nurses, technicians and social workers, innovators and educators, and so many others. All with a shared vision for what healthcare can and should be. We are committed to attracting, developing and retaining top talent. We strive to create a diverse and inclusive workplace that reflects the communities in which we work and serve. With a team approach to care, we encourage learning and growth at all levels and offer competitive salaries and benefits.
Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.