Behavioral Health RN Case Manager – 20hrs

80501BR

Patient Services-Patient Care Operations

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Status
Part-Time

Standard Hours per Week
20

Job Category
Nursing,

Regular, Temporary, Per Diem
Regular

Office/Site Location
Boston

Remote Eligibility
Part Remote/Hybrid

Job Posting Description

At Boston Children’s Hospital, the quality of our care – and our inclusive hospital working environment – lies in the diversity of our people. With patients from local communities and 160 countries around the world, we’re committed to reflecting the spectrum of their cultures, while opening doors of opportunity for our team. Here, different talents pursue common goals. Voices are heard and ideas are shared. Join us, and discover how your unique contributions can change lives. Yours included.

Position Summary:
The UM Case Managers at Boston Children’s review documentation within 1 business day of patient admission to assess for the appropriateness of an inpatient status, and regularly provide reports to insurers to update them on the plan for care of hospitalized patients. They work alongside Patient Financial Services staff, assisting with obtaining authorizations for the appropriate level of care for admissions and with post-discharge appeals of payer denials. They identify and implement initiatives to manage utilization trends, collaborating with the hospital’s discharge planning case managers, healthcare team, and Patient Financial Services. They are part of an interdepartmental team that works to ensure appropriate patient access to services and efficient use of hospital resources.

Key Responsibilities:

  • Assessing, planning, organizing and overseeing daily clinical operations of care coordination and transitions to address the comprehensive and complex health needs of the patient and family.
  • Possessing knowledge of mental health community based services and those included in the Child Behavioral Health Initiative
  • Possessing understanding of the concurrent review process for acute psychiatric care
  • Possessing experience in Utilization Management/Utilization Review
  • Demonstrating the ability to integrate regulatory requirements, length of stay, resource allocation, funding sources, and capacity management to optimize delivery of appropriate services.
  • Actively participating, as required, in clinic/hospital, departmental and multidisciplinary programs, committees and special projects.
  • Working 20 hours per week/40 hours per pay period : 8 hour shifts, Mondays – Fridays. This is a hybrid role with primarily remote work but may need to be on campus at times. Must live within commuting distance of main hospital

Minimum Qualifications
Education:

  • A Bachelor’s degree in nursing.
  • Master’s in a related Healthcare field preferred.

Experience:

  • 5 years nursing experience required, psychiatric nursing experience preferred.
  • Experience as a Case Manager (Discharge Planning and or Utilization Management) preferred.

Licensure/ Certifications:

  • Current Massachusetts license as a Registered Nurse (RN)
  • A certification as a Certified Case Manager (or other pediatric specialty certification like CPN or CCRN) is preferred.

Boston Children’s Hospital offers competitive compensation and unmatched benefits including flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.

Boston Children’s Hospital requires all employees to be vaccinated against COVID-19 and Flu, (unless you are eligible for a medical or religious exemption).

Boston Children’s Hospital is an Equal Opportunity / Affirmative Action Employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability.

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