Nurse Case Manager

Countryside Health Care of Milford is seeking a Nurse Case Manager to join our team!

Qualifications: 

• Current Registered Nurse or Licensed Practical Nurse license in the Commonwealth of Massachusetts

• Able to read, write, speak and understand the English language

• Computer literacy is desirable

• Excellent communication and interpersonal skills

• Must possess the ability to make independent decisions when circumstances warrant such action.

• Must posses the ability to deal tactfully with personnel, residents, family members, visitors, government agencies, and the general public.

• Must be knowledgeable of nursing and medical practices and procedures, as well as laws, regulations and guidelines that pertain to short-term and long-term care.

• Must posses the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies and procedures, etc. that are necessary for providing quality care.

• Must be able to move intermittently throughout the workday.

• Must meet the general health requirements set forth by the policies of this facility

Purpose:  In collaboration with other members of the healthcare team, the case manager is accountable for coordinating and facilitating the management of care for an assigned group of patients to ensure provision of a well-coordinated individualized care experience through the delivery of outcome orientated patient care within a fiscally responsible framework.

Duties and Responsibilities:

• Welcome residents and orient them to the environment.

• Greet newly admitted residents upon admission and escort patient to their room if necessary.

• Ensure that rooms are ready for new admissions.

• Maintain an adequate liaison with families and residents.

• Confer with the Medical Director and the attending physician concerning a patient’s history.

• Initiate requests for consultations or referral and respond to requests from the resident, physician, or nursing staff.

• Perform administrative duties regarding completion of forms, reports, evaluations, studies, charting, etc.

• Coordinate the admission and/or discharge of residents as necessary.

• Assist the resident and interdisciplinary team in planning the resident’s discharge plan.

• Determines appropriateness of inpatient admission.

• Participate as requested by the Staff Development Coordinator or Director of Nursing Services in the planning and conducting of in-service training classes.

• Attend and participate in continuing educational programs designed to keep you abreast of changes in your profession, as well as to maintain your license on a current status.

• Monitor the activities of and care provided to all residents to ensure that they are treated fairly and with kindness, dignity, and respect.

• Participate in the interviewing and selection of residents for admission to the facility, including the screening process.

• Provides tours of the facility.

• Assessment in accordance with facility policies and procedures as well as regulatory reimbursement and accrediting agency standards and criteria.

• Plans care with team members to ensure maximum effectiveness in patient outcomes and satisfaction by ensuring contribution of all care providers toward achievement of quality patient outcomes.

• Establish regular plan of communication with other members of the health care team as evidenced by ongoing knowledge of the status of the patients and performs rounds.

• Initiates discussion relevant to potential alternatives to planned interventions based on clinical knowledge of the situation.

• Performs concurrent/retrospective review to determine appropriateness of setting and services according to level of care criteria, in order to manage length of stay and facilitate discharge planning.

• Functions as a liaison between payers and clinical staff to ensure that guidelines for continued coverage are met.

• Maintains and enhances his/her own professional expertise and knowledge of current regulatory stands, reimbursement mechanisms, clinical advances, and community resources.

• Provides confidentiality to all work-related information. Maintain confidentiality of all pertinent personnel information in accordance with the privacy act, as well as our established personnel policies governing the release of information.

• Demonstrates the ability to identify patient/resident needs.

• Displays ability to respond constructively to peer and supervisory suggestions and direction.

• Correspond with insurers regarding admission and continued stay criteria to ensure reimbursement.

• Provide the Administrator with information relative to the nursing needs of the resident and the nursing services department’s ability to meet those needs.

• Inform nursing service personnel of new admissions. Their expected time arrival, room assignment, etc.

• Review nurses’ notes to ensure that they are informative and descriptive of the nurse care being provided, that they reflect the resident’s response to the care, and that such care is provided in accordance with the resident’s wishes.

• Schedule rounds to observe residents and to determine if nursing needs are being met in accordance with the resident’s request.

• Review nurses notes to determine if the care plan is being followed.

• Assist the Resident Assessment/Care Plan Coordinator in planning, scheduling, and revising the MDS.

• Develop and maintain a good rapport with all services involved with the care plan to ensure that a team effort is achieved in developing a comprehensive plan of care.

• Participate in developing, implementing, and periodically updating the residents written discharge plan.

• Represent the facility at and participate in top level meetings.

• Make written and oral reports/recommendations to the administrator concerning the operation of the facility.

• Participate in facility surveys (inspections) made by authorized government agencies.

• Assist in setting the tone and atmosphere of the facility.

• Serve as liaison to the Administrator, medical staff, and other professional and supervisory staff.

• Participate in the facility’s on-call rotation schedule.

• Perform other duties as assigned.