RN Case Manager - Full-Time, Case Management

Case Manager, RN - Full-Time

Tufts Medical Center is a world-renowned academic medical center that has been caring for patients across New England for more than 200 years. As the principal teaching hospital of Tufts University School of Medicine and a nationally respected research institution, we are known for delivering groundbreaking, patient-centered care across more than 100 specialties and services, from primary care to our Level I Trauma Center to the region's leading heart transplant program.

Nurses are at the heart of that mission.

As a Magnet designated organization, Tufts Medical Center offers nurses the opportunity to practice at the highest level grounded in teamwork, clinical inquiry, and a culture of continuous improvement. We are committed to advancing nursing through evidence-based care, shared decision-making, and strong interdisciplinary collaboration.

Nurses at Tufts MC are deeply integrated into all aspects of clinical care and operations. Whether providing high-acuity specialty care or leading quality and safety initiatives, our nurses are respected as full partners in care delivery and innovation. Their insight drives progress. Their expertise shapes outcomes.

Nurses are supported through strong peer networks, diverse clinical experiences, and opportunities for professional development. Professional growth is expected, encouraged, and championed.

At Tufts Medical Center, nursing isn't just supported but integral to who we are. Join us and be part of a team that's leading with purpose and redefining what's possible in healthcare.

Job Overview

This position is responsible and accountable for the management of care for an assigned patient population by unit, across the continuum of care. The Case Manager works to achieve daily clinical, quality and cost outcomes by providing well-coordinated experiences for patients/families through the synchronization of care activities of multiple disciplines and negotiating with third party payors. This is accomplished by negotiating, procuring and coordinating services and resources needed by patient/family; ensuring and facilitating the achievement of quality and clinical customer service; cost and clinical outcomes; intervening at key points for individual patients; addressing and resolving patterns or issues that have a negative quality-cost impact; and creating opportunities and systems to enhance outcomes.

Job Description

Minimum Qualifications:

1. Associate's Degree in Nursing.

2. Basic Life Support (BLS) Certification.

3. Registered Nurse (RN) License.

4. Three (3) years of Case Management experience.

5. Certifications (i.e. ACLS, PALS) relevant to the department and type of care being provided may be required.

Preferred Qualifications:

1. Bachelor's Degree in Nursing.

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.

1. Completes assessments on all new admissions to determine the need for all appropriate Case Management services.

2. Conducts daily multidisciplinary rounds on assigned units, reviews patient's plan of care and coordinates including: Assessment of patient/family needs; Completion and report of diagnostic tools in a timely manner; Completion of treatment appropriate for the acute episode of illness; Modification of plan to meet continuing care needs of the patient; and Monitors ongoing process of gathering adequate information from all relevant sources to insure operation of plan.

3. Discusses estimated length of stay, treatment and discharge plan with the attending physician and healthcare team by establishing strong, collaborative relationships with physicians and team members and discusses the appropriateness of resource utilization, consults and treatment plan.

4. Ensures that the interdisciplinary care plan and discharge plan are consistent with the patient's clinical course, covered services and continuing care needs.

5. Identifies patients and families with complex psychosocial, financial and legal discharge planning needs and refers them to social work.

6. Incorporates knowledge of clinical expertise, quality initiatives, insurance and finance into decision-making and problem solving of individual patient cases and across case type during care management activities.

7. Fosters and maintains a positive working relationship with referral agencies and liaisons to enhance patient flow.

8. Collects and reports on quality projects, i.e. CHF; Re-admissions within 30 days; Delay Day Variances; Risk management; and Quality improvement.

9. Documents patient/family progress towards discharge and all critical events and information associated with the hospital stay in SoftMed.

10. Supports the EMR and all computer programs, including SoftMed and Soarian.

11. Using Interqual criteria, reviews appropriateness of admission, the need for continued stay and information needed for discharge.

12. Responds to third party payor requests for concurrent clinical information in timely manner.

13. Ensures that documentation in the medical record supports the admission and continued stay, in order to reduce denial rate.

14. Documents care management activities in the initial assessment and as the patient progresses towards discharge and at discharge.

15. Interacts with Admitting, Financial Counselors, Insurance Case Managers, Finance and Screeners as appropriate.

16. Maintains clinical competency and current knowledge of regulatory and payor requirements to perform job responsibilities.

17. Works with documentation specialist to have accurate length of stay information.

18. Provides superior customer services to all internal and external clients, customers and patients

19. Completes roles and functions related to discharge planning/coordination including case identification, high risk screening, assessment of patient and resources, goal setting, implementing, maintaining and evaluating process. Goal is to complete within 24 hours.

20. Coordinates all discharge activities and initiates all appropriate referrals to continuum of care agencies in a timely manner.

21. Facilitates patient transfer from one level of care to the next.