RN Case Manager for Dual Eligible Special Need Plan (D-SNP)

Site: Mass General Brigham Community Physicians, Inc.
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
The Opportunity
The RN Case Manager serves as a core member of the care team by coordinating and supporting healthcare within the facility and coordinating referrals for services outside the clinic. The RN provides outreach and enrollment services to meet eligibility requirements of the program and surrounding counties, and ensures coordination and planning, including community and family support, by focusing on the development and coordination of community service plans and partnering with service providers, families, and patients to create a plan of healthcare.
Job Summary
Essential Functions
- Conduct client assessments and planning.
- Modify patient treatment plans as indicated by patients' responses and conditions.
- Prepare patient/family for discharge.
- Communicate with third party payers to obtain necessary authorization for reimbursement of services.
- Define care goals of patients by providing education, information, and direction to each individual and family.
- Review cases with medical directors on challenging cases as needed.
- Maintain accurate, detailed reports and records.
Qualifications
What You'll Bring:
- Associate's Degree Nursing required (Bachelor's Degree Nursing preferred).
- Active and unrestricted Registered Nurse (RN) Licensure for the state of Massachusetts required.
- 2+ years of case management and/or discharge planning required.
- Experience working with complex dually eligible populations required.
- Knowledge of Managed Care preferred.
- Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care preferred.
- Utilization Review experience preferred.
Additional Skills and Abilities:
- Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
- Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
- Ability to establish strong rapport and relationships with patients and staff.
- Proficient in Microsoft Office and industry related software programs.
- Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
- Ability to maintain client and staff confidentiality.
Additional Job Details (if applicable)
Schedule and Working Model:
- Full-time (40 hours) Monday through Friday, ~8:30am-5pm.
- Hybrid: Approximately 2 days per week in the field and 3 days per week at home, with flexibility as needed.
Remote Type
Hybrid
Work Location
399 Revolution Drive
Scheduled Weekly Hours
40
Employee Type
Regular
Work Shift
Day (United States of America)
Pay Range
$58,656.00 - $142,448.80/Annual
Grade
98TEMP
At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
EEO Statement:
Mass General Brigham Community Physicians, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at .
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.