Nursing Jobs in Weston, MA
$123,593.60 - $183,726.40 / year
If you are an existing employee of South Shore Health then please apply through the internal career site. Requisition Number: R-23870 Facility: LOC0001 - 55 Fogg Road55 Fogg Road Weymouth, MA 02190 Department Name: SSH Care Progression Status: Full time Budgeted Hours: 40 Shift: Day (United States of America) Under the general supervision of the Case Management Manager acts as a patient advocate/Case Manager to SSH&EC clients. An autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost efficient patient outcomes. Looks for opportunities to reduce cost while assuring the highest quality of care is maintained. Applies review criteria to determine medical necessity for admission and continued stay. Provides clinically-based case management, discharge planning and care coordination to facilitate the delivery of cost-effective quality healthcare and assists in the identification of appropriate utilization of resources across the continuum of care. Works collaboratively with interdisciplinary staff internal and external to the Organization. Participates in quality improvement and evaluation processes related to the management of patient care. The Case Manager is on-site and available seven (7) days a week as well as holidays and, therefore, is required to work a weekend rotation and also an occasional holiday. Compensation Pay Range: $123,593.60 - $183,726.40 1 - The RN Case Manager is responsible for reviewing the medical record of all observation and inpatient admissions and continued stays to ensure appropriate utilization and delivery of care. a - Using Interqual Criteria, physician certification, and payor specific criteria, assists the physician in determining the medical necessity for observation, admission and continued stays. b - Identifies cases daily that fail to meet criteria and refers these cases to appropriate manager or physician advisor for secondary review. c - Contacts attending physicians daily on cases that lack adequate documentation warranting acute hospitalization and clarifies for them the necessary clinical documentation required to help support medical necessity d - Contacts the attending physician to notify him/her of decision to issue notice of non-coverage. Explains UR process and insurance coverage requirements. Obtains physician written concurrence when necessary; e.g., Medicare patients. Informs the patient and/or next of kin when insurance coverage must be terminated for the current admission. Issues the termination letter for the Medicare patient e - Reinstates insurance coverage when patient condition becomes acute and meets criteria again. Issues reinstatement letter. f - Continues review of all patients using criteria and determines need for continued hospitalization based upon third party payor/insurance guidelines. g - Provides clinical data/information to contracted third-party payers while patient is hospitalized to ensure continued reimbursement and to avoid reimbursement delays within 24 hours of request. h - Continues review of all patients using criteria and determines need for continued hospitalization based upon third party payer/guidelines. 2 - Plays an essential role in assisting physicians, nursing and staff with accurate determination of a patient’s observation status. The RN Case Manager is an important resource in preventing delayed discharges of observation patients. a - Identifies and reviews observation patients to determine the correct patient level of care daily prior to 12 PM. b - Consults with physicians, nursing, admitting, and outside insurance case managers to determine the appropriate status of patient. Refers the questionable status to internal physician advisor or EHR according to the Departmental Process. c - Assumes the role of review coordinator for observation services; reviews medical record for appropriateness of status and level of care, and facilitates the level of care, utilizing InterQual for Observation. d - Works with physicians, nursing and staff, patients and families to arrange prompt and safe discharge e - RN Case Manager must take telephone orders from physicians changing patient status from observation to inpatient admission. This should be done when monitoring observation status. A call or page should be made to physician if the RN Case Manager believes that this should be an inpatient admission and not wait until the 24 hours are ending before conversion. RN Case Manager must actively monitor patients on observation status and seek to clarify their status as close to the 24-hour benchmark as possible. The RN Case manager must send a concern in a timely fashion to facilitate the patient being put into the correct patient status and to provide timely notification. 3 - Participates in case finding and pre-admission evaluation screening to assure reimbursement. a - Identifies potential transition planning problems in a timely manner to set up services required. b - Works with attending physician to move patient through the SSH&EC system and set up appropriate services or referrals; e.g., SNF/VNA/Home Pharmacy c - Identifies need for new resources if gaps exist in service continuum, and initiates creative care delivery options. 4 - The RN Case Manager is responsible for assessing patient acute level of care needs and works to implement and coordinate interventions aimed at facilitating a safe and timely discharge plan to the appropriate sub-acute settings in collaboration with the Case Manager Specialist. a - With the Case Manager, work to identify, and prioritize workflow through identification of patient specific, department needs and or unit based needs. b - Executes and implements a safe and effective discharge plan based on the case management assessment in accordance with the Conditions of Participation. c - Makes and documents appropriate changes to discharge plan when necessary. d - Proactively uncovers barriers to early/timely discharge and overcomes them. e - Facilitates and coordinates patient care rounds. f - Conducts necessary conferences and team meetings regarding specific patient needs. g - Implements interventions that lead to patient accomplishing goals established in Plan. h - Coordinates the necessary resources to accomplish goals developed in Plan. i - Proactively affects system to facilitate efficient flow of care, anticipates discharge process. j - Gathers information from multidisciplinary team and monitors appropriate discharge plan. 5 - Continued. a - Uses and Updates the interdisciplinary patient White Board for communication enhancement; including RN Case Manager name, time/date/plan for discharge. b - Issues the Medicare Important Message (IM). c - Proper use of the Medical Necessity form for post discharge transportation. d - Use of technical tools, i.e., eDischarge, EHR, Interqual, MCCM e - Identifies and / or facilitates establishment of a patient’s Health Care Proxy.p) f - Identifies patient Care Plan Partner. g - Fosters patient and family awareness of Patient Portal. 6 - Ensure that patient has received all information related to choice of follow-up care facilities according to patient and family preference and any ACO preferred contracted providers. a - Ensure that, at minimum, 3 referrals are processed for continuum of care providers b - Document choices provided, with special consideration of ACO relationships and preferences; and selections made by patient and/or family in medical record. c - Expedite and process referrals, in a timely manner to department standards, including requesting and tracking screenings and acceptances of patients by care providers, expediting responses from provider facility personnel as necessary. d - Document response by providers. e - Delivers the Medicare Important Message (IM) per department protocol. f - Have patient, family/healthcare Proxy sign discharge plan. 7 - Interacts, communicates, and intervenes with multi-disciplinary healthcare team in a purposeful, goal-directed fashion. Works pro-actively and utilizes critical thinking skills to maximize the effectiveness of resource utilization. Anticipates, initiates, and facilitates problem resolution around issues of resource use and continued hospitalization, discharge planning. a - Establishes a means of communicating and collaborating with physicians, other team members, the patient’s payers, and administrators. b - Explores strategies to reduce length of stay and resource consumption within the care managed patient populations, implements them and documents the results. c - Communicates to appropriate members of healthcare team patients at risk of losing insurance coverage via termination of benefits, facilitates discharge plan d - Maintains a pro-active role to ensure appropriate documentation concurrently to minimize inefficient resource utilization and prevent loss of reimbursement e - Reviews physician documentation and follows procedures to seek clarification where indicated of that documentation relative to diagnosis and comment on the patient’s clinical state. f - Coordinate and participate in daily multidisciplinary patient care rounds. g - Uses the SBAR method to communicate with MD, and peers h - Acts as a clinical resource to support the Case Manager Specialist in resource utilization and discharge planning the more clinically complex or long length of stay patient. 8 - Establishes and maintains effective communication with all referral sources, insurers, vendors and patient supplier systems. 9 - Maintains consistently a professional commitment to institutions and department’s goals and objectives. Demonstrates flexibility to the department’s needs in relation to floor and work schedule, and any other internal and external demands on the department. Continually shows commitment to the Department by extending self when need arises. 10 - Maintains an updated knowledge base of and references resources outlining provider benefits for care choices, including public, private, and governmental payers and established / preferred ACO relations a - Maintains a working knowledge of the requirements of the payers most frequently seen with the patient population. b - Maintains a working knowledge of the resources available in the community for patients/families. c - Maintains current nursing licensure CEU credits, case management certification CEU's. d - Maintains Interqual Certification. 11 - Is responsible for department operational excellence, regarding safe and effective discharge planning; assures department delivers quality services in accordance with applicable policies, procedures and professional standards. a - Manages all activities so that quality services are provided in an efficient and effective manner. b - Services provided meet all applicable regulatory requirements c - Participates in departmental and organizational Quality Improvement initiatives involving the Lean principles and TIM WOODS. d - Maintains departmental productivity measurements. e - Has an awareness of departmental productivity measurements including LOS and utilization f - Follows department policies, procedures, and standards of care that support operational excellence and productivity measurements 12 - Attains all agreed to goals and objectives within specified time frames, as part of the organization’s overall mission. 13 - Technology – Embraces technological solutions to work processes and practices. a - eDischarge, EHR, Interqual, MCCM, Epic, Workday JOB REQUIREMENTS Minimum Education - Preferred Registered Nurse, Bachelors prepared strongly preferred Minimum Work Experience 3-5 years acute care hospital experience preferred Critical Care or Emergency Department experience highly desirable Required Licenses / Registrations RN - Registered Nurse Required Certifications ACM - Accredited Case Manager or CCM - Certified Case Manager within two years of hire. Required additional Knowledge, and Abilities Demonstrated skills in the areas of: negotiation, communication (verbal and written), conflict, interdisciplinary collaboration, management, creative problem solving, and critical thinking, time management and ability to multitask in high stress environment. Knowledge of: healthcare financing, community and organizational resources, patient care processes, and data analysis. Knowledge of utilization management as it relates to third party payers Knowledge of post-acute care community resources Experience with Managed Care preferred. Excellent verbal and written communication skills required. Demonstrates flexibility via an ability to adapt to changing priorities and regulations. Monday - Friday with a weekend and holiday requirement. Full-time position with option of 5/8hour or 4/10hour shift. Responsibilities if Required: Education if Required: License/Registration/Certification Requirements: Accredited Case Manager (ACM) - National Board for Case Management (NBCM) - National Board for Case Management (NBCM), Certified Case Manager (CCM) - Commission for Case Manager Certification (CCMC) - Commission for Case Manager Certification (CCMC), RN-Registered Nurse - Board of Registration in Nursing (Massachusetts) 
$70,699.20 - $136,801.60 / year
If you are an existing employee of South Shore Health then please apply through the internal career site. Requisition Number: R-23908 Facility: LOC0028 - 30 Reservoir Park Drive30 Reservoir Park Drive Rockland, MA 02370 Department Name: SSH VNA Team 1 Status: Full time Budgeted Hours: 36 Shift: Day (United States of America) Responsible as a member of the interdisciplinary team to the Director and Nurse Manager for assigned functions related to providing information about services to potential South Shore Health Home care patients and admitting patients to South Shore Health Homecare patients Compensation Pay Range: $70,699.20 - $136,801.60 Advanced clinical and assessment skills with ability to deal with a variety of clinical situations. Pain management experience , Critical thinking, ability to multi-task, excellent communication skills, ability to work within a team or autonomously, Flexible, excellent attention to details, well-developed documentation skills, computer experience, teaching skills. 4- 9 hour days (Mon-Fri.), every 4th weekend, 1 holiday/year Responsibilities if Required: Education if Required: License/Registration/Certification Requirements: RN-Registered Nurse - Board of Registration in Nursing (Massachusetts) 
$101,025.60 - $181,854.40 / year
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: Exempt Hiring Range: $101,025.60 - $181,854.40 Please note that the final offer may vary within this range based on a candidate’s experience, skills, qualifications, and internal equity considerations . Schedule Details: Monday through Friday Scheduled Hours: 8:00 - 5:00pm Shift: 1 - Day Shift, 8 Hours (United States of America) Hours: 40 Cost Center: 10020 - 4087 Oncology Clinic Marlborough 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 20,000 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. Responsible for directing and coordinating daily departmental function and planning for the delivery of optimal family-centered patient care. Collaborates with the Manager Ambulatory Operations to manage and direct the implementation of professional nursing practice on a day-to-day basis. Coordinates age-appropriate patient care activities for a defined staff and makes immediate decisions for those areas within the scope of his/her responsibility using knowledge of standards, policies and procedures as they apply to the given area. As part of the management team participates in strategic planning, implementation, evaluation, and revision of systems to support and enhance the competence, autonomy, and accountability of the nursing staff. Manages and directs day-to-day work responsibilities for the Ambulatory areas to assure optimal patient flow and satisfaction. I. Major Responsibilities: 1. Coordinates clinical practice and deployment of resources at the unit level for staff to ensure implementation of clinical processes, adherence to standards, and compliance with regulatory standards. 2. Keeps Manager Ambulatory Operations informed of nursing workload, changes in patient and employee needs, and other problems. 3. Assists in directing patient flow between the assigned Ambulatory areas. 4. Assesses the number and competency level of staff in each assigned area and adjusts staffing appropriately to meet patient care needs. 5. Facilitates communication between nursing and other disciplines. 6. Identifies issues in nursing care delivery and seeks solutions for problems. Documents actions taken. 7. With the Manager Ambulatory Operations, ensures the nursing practice standards, health and safety requirements are met. 8. Disseminates information on new and revised policies and procedures. 9. Inspires and encourages teamwork. 10. Demonstrates decision-making skills be establishing priorities and initiating action. Coordinates and implements day-to-day work assignments for staff. 11. Identifies learning needs of staff and initiates action to facilitate meeting those needs. 12. Provides opportunities for skill development for staff. 13. With the Manager Ambulatory Operations, participates in the interview and hiring processes for new employees. 14. Coordinates orientation schedule and assignments for orientees assigned to the unit. Assists Manager Ambulatory Operations to ensure that staff attain defined competencies. 15. Actively participates in evaluation of staff performance for his/her assigned shift. 16. Provides immediate disciplining and counseling to staff as necessary. Makes recommendations to Manager Ambulatory Operations regarding need for further disciplinary action. 17. Actively participates in quality assurance activities. 18. Serves as a role model for professional nursing practice. 19. Exercises cost-containment strategies and educates staff in such practices. 20. Provides input to the preparation of the annual budget. 21. Maintains open lines of communication with Manager Ambulatory Operations, other departments, staff, physicians, resident staff, and other support personnel. 22. Identifies and participates in educational programs to strengthen both clinical and management expertise. Standard Management Level Responsibilities: 1. Directs and supervises assigned personnel including performance evaluations, scheduling, orientation, and training. Makes recommendations on employee hires, transfers, promotions, salary changes, discipline, terminations, and similar actions. Resolves grievances and other personnel problems within position responsibilities. 2. Develops and recommends the budgets for the areas managed. Manages activities to assure financial goals are met. 3. Coordinates the assignment of tasks and helps resolve technical and operational problems. Evaluates the impact of solutions to ensure goals are achieved. 4. Provides effective direction, guidance, and leadership over the staff for effective teamwork and motivation and fosters the effective integration of efforts with system-wide initiatives. 5. Encourages and supports diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, respect, tolerance, civility and acceptance toward all employees, patients and visitors. 6. Integrates diversity into departmental objectives, such as hiring, promotions, training, vendor selections, etc. 7. Participates in performance improvement initiatives and demonstrates the use of quality improvement in daily operations. 8. Ensures compliance with regulatory agencies such as Joint Commission, DPH, etc. Develops and maintains procedures necessary to meet regulatory requirements. 9. Ensures that department complies with hospital established policies, quality assurance programs, safety, and infection control policies and procedures. 10. Ensures adequate equipment and supplies for department. 11. Develops and maintains established departmental policies, procedures, and objectives. 12. Ensures compliance to all health and safety regulations and requirements. 13. Maintains, regular, reliable, and predictable attendance. 14. Performs similar or related duties as required or directed. All responsibilities are essential job functions. II. Position Qualifications: License/Certification/Education: Required: 1. Bachelor’s degree in nursing or management experience. 2. Current Massachusetts Registered Nurse licensure and registration. Experience/Skill: Required: 1. Minimum of two years related clinical experience and at least one year experience in the clinical preceptor and/or resource role. 2. Demonstrates leadership experience. 3. Excellent verbal and written communication skills. 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. Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents. The Organization reserves the right to modify position duties at any time. III. Physical Demands and Environmental Conditions: Work is considered moderate, frequent walking, standing and potential exposure to hazardous materials including blood and bodily fluids. Position requires work indoors in a patient care environment. All 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. 
