UMass Memorial Health
Care Coordinator/Care Manager
UMass Memorial Health, Worcester, Massachusetts, us, 01609
Are you an internal caregiver, student, or contingent worker/agency worker at UMass Memorial Health? CLICK HERE to apply through your Workday account.Exemption Status:
ExemptSchedule Details:
Monday through FridayScheduled Hours:
0Shift:Hours:
40Cost Center:This position may have a signing bonus available. A member of the Recruitment Team will confirm eligibility during the interview process.Everyone Is a Caregiver:
At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence, and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community, and each other. And everyone, in their own unique way, plays an important part, every day.I. Major Responsibilities:
Performs assessment of patient's physical, functional, and psycho-social needs through the use of screening tools, direct patient and family communication, medical record review, and discussions with other caregivers providing services to the patient. Identifies complex patients in need of intensive case management based on established clinical and financial criteria.Performs admission and concurrent reviews as assigned. Performs inpatient reviews in accordance with payer requirements utilizing clinical criteria sets. Meets with third-party case managers to discuss cases and assures timely communication of relevant clinical information to third-party payers as required. Educates practitioners on the level of care and documentation requirements.Collaboratively facilitates the care of patients throughout the continuum of care. Works as a team member to support/collaborate with Care Coordination Team for monitoring level of care, and for identification of trends in clinical practices and opportunities for improvement.Works with patients and families to establish objectives, goals, and an action plan to meet the patient's individual needs within the indicated level of care. Collaborates with the physicians, other care providers, and community resources in the care planning process.Contacts third-party payer to clarify benefit eligibility, coverage, and available resources for patients. May negotiate conversion of benefits for previously non-covered services. Researches alternate sources of funding for non-reimbursed services that are part of the patient's treatment plan.Coordinates, implements, monitors, and evaluates outcomes of the discharge plan. Evaluates progress of this plan with the discharge planner, patient, family, and the patient's health care insurer. Goals, interventions, and time frames are revised as needed as a means of assisting the patient to achieve his/her optimal level of health and functionality.Continually evaluates the patient's level of care. Educates the patient, family, and care team regarding resource options, facilitates decision making, initiates plans, and secures resources for the patient on an ongoing basis in complex cases.Participates in quality improvement on a system level through identification of opportunities for improvement, collection and analysis of data, and participation in the development and application of revised processes. Supports departmental and medical center-wide performance improvement programs such as implementation and monitoring of clinical practice guidelines.Fosters compliance with regulatory requirements, good practice, and patient care.II. Position Qualifications:
License/Certification/Education:
Required:Massachusetts licensure as a registered nurseExperience/Skills:
Required:Three (3) years clinical experience in discharge planning or case management.Ability to effectively use specialized computer-based systems for the gathering, reporting, and analysis of clinical data.Excellent organizational and communication skills.Preferred:Utilization management and third-party payer knowledge.Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.III. Physical Demands and Environmental Conditions:
Constantly:Working indoorsFrequently:Sitting, standing, walking, reaching, grasping, repetitive movements, high stress level, color visionPrecise motor skills, hearing, visionLifting, carrying, pulling, pushing 0-10 poundsOccasionally:Pushing, pulling, twisting, climbing, balancing, bending, temperature extremesKneelingLifting, carrying, pulling, pushing 10-20 poundsAll qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community, and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player, and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.
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ExemptSchedule Details:
Monday through FridayScheduled Hours:
0Shift:Hours:
40Cost Center:This position may have a signing bonus available. A member of the Recruitment Team will confirm eligibility during the interview process.Everyone Is a Caregiver:
At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence, and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community, and each other. And everyone, in their own unique way, plays an important part, every day.I. Major Responsibilities:
Performs assessment of patient's physical, functional, and psycho-social needs through the use of screening tools, direct patient and family communication, medical record review, and discussions with other caregivers providing services to the patient. Identifies complex patients in need of intensive case management based on established clinical and financial criteria.Performs admission and concurrent reviews as assigned. Performs inpatient reviews in accordance with payer requirements utilizing clinical criteria sets. Meets with third-party case managers to discuss cases and assures timely communication of relevant clinical information to third-party payers as required. Educates practitioners on the level of care and documentation requirements.Collaboratively facilitates the care of patients throughout the continuum of care. Works as a team member to support/collaborate with Care Coordination Team for monitoring level of care, and for identification of trends in clinical practices and opportunities for improvement.Works with patients and families to establish objectives, goals, and an action plan to meet the patient's individual needs within the indicated level of care. Collaborates with the physicians, other care providers, and community resources in the care planning process.Contacts third-party payer to clarify benefit eligibility, coverage, and available resources for patients. May negotiate conversion of benefits for previously non-covered services. Researches alternate sources of funding for non-reimbursed services that are part of the patient's treatment plan.Coordinates, implements, monitors, and evaluates outcomes of the discharge plan. Evaluates progress of this plan with the discharge planner, patient, family, and the patient's health care insurer. Goals, interventions, and time frames are revised as needed as a means of assisting the patient to achieve his/her optimal level of health and functionality.Continually evaluates the patient's level of care. Educates the patient, family, and care team regarding resource options, facilitates decision making, initiates plans, and secures resources for the patient on an ongoing basis in complex cases.Participates in quality improvement on a system level through identification of opportunities for improvement, collection and analysis of data, and participation in the development and application of revised processes. Supports departmental and medical center-wide performance improvement programs such as implementation and monitoring of clinical practice guidelines.Fosters compliance with regulatory requirements, good practice, and patient care.II. Position Qualifications:
License/Certification/Education:
Required:Massachusetts licensure as a registered nurseExperience/Skills:
Required:Three (3) years clinical experience in discharge planning or case management.Ability to effectively use specialized computer-based systems for the gathering, reporting, and analysis of clinical data.Excellent organizational and communication skills.Preferred:Utilization management and third-party payer knowledge.Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.III. Physical Demands and Environmental Conditions:
Constantly:Working indoorsFrequently:Sitting, standing, walking, reaching, grasping, repetitive movements, high stress level, color visionPrecise motor skills, hearing, visionLifting, carrying, pulling, pushing 0-10 poundsOccasionally:Pushing, pulling, twisting, climbing, balancing, bending, temperature extremesKneelingLifting, carrying, pulling, pushing 10-20 poundsAll qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community, and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player, and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.
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