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RN Team Lead - Case Management

Jordan Hospital Inc. - Plymouth, MA


Coordinates continuing care services to include utilization review, management and discharge planning activities.

Reviews admission data on inpatients to establish appropriateness of the admission using Interqual criteria.

Coordinate continuing care and utilization review for SDC, ED and other outpatient areas on request.

Conducts concurrent reviews to determine the continued need for acute care setting, appropriateness and timeliness of treatments/procedure and to optimize the potential for reimbursement.

Identifies continuing care needs or potential home care recipients through assessment, interdisciplinary care rounds and/or requests.

Establishes coordinated discharge plans based on the patients assessed needs, available family support, available community services, and the patients/families choice.

Arranges for home care services, such as skilled nursing, durable medical equipment and community services.

Interfaces with external reviewing agencies and/or Case managers regarding medical necessity, appropriateness of care, ongoing treatment plan and post-hospital discharge plan in order to ensure patient care needs are met.

Consistently models effective communication and overall leadership qualities necessary to promote staff accountability and a positive work environment.

Demonstrates sound judgment and critical thinking skills

Coordinates and participates in educational opportunities and performance improvement activities.

Participates in mentoring and reporting on progress of personnel, to include existing staff as well as new hires.

Participates in the assessment of staff performance in collaboration with department management.

Ensures departmental documentation is to the level expected, and that is done in a standardized approach.

Attends operational meetings in relation to the Case Management/Utilization Review workflow processes.

It is understood that this is a summary of key job functions and does not include every detail of the job that may reasonably be required.

Experience/Knowledge/Skills Required

RN licensure and a Bachelor's degree in nursing, health care administration or a related field preferred or commensurate experience

Demonstrated leadership ability including time management, training/mentoring, relationship management/team building, conflict resolution and prioritizing assignments

A minimum of three years current experience with case management and utilization management in a Hospital setting required

Ability to identify appropriateness of patients admission and level of care needs (inpatient and observation) utilizing Interqual criteria

Knowledge of Interqual and Allscripts systems preferred

Strong interpersonal and negotiation skills demonstrated by a positive attitude, pleasant, professional and cooperative demeanor with patients, physicians, fellow employees, and insurance companies.

Computer skills, including Microsoft Outlook, Word, Excel and Meditech

Ability to work independently


Massachusetts RN License.

Certification in Utilization Review and/or Management or Case Management

14 days 7 hours ago

Jordan Hospital Inc.


RN Team Lead - Case Management Jordan Hospital Inc. - Plymouth, MA, United States


Location: Plymouth, MA