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Case Manager

Company Name:
Hallmark Health System
The Case Manager is responsible for the integration, coordination, and advocacy for patients and families requiring post-hospital services. Achieves optimal patient outcomes by assessing, planning and arranging for post-acute transitions. The Case Manager ensures medical necessity of hospitalization and treatment in accordance with hospital and third party payor guidelines and criteria. This position ensures appropriate utilization of hospital resources and works with other physicians and health care team members to manage care in a cost-effective and efficient manner. Achieves planned care outcomes by planning and arranging services on discharge.
Graduate of an Accredited School of Nursing required; BSN strongly preferred. Registration and current Massachusetts RN Licensure in good standing required. Candidates who do not have a Bachelor''s Degree in Nursing may be considered, but must be enrolled in a Baccalaureate program within 1 year of hire. Professional certification highly encouraged. 2 years of experience in a Medical/Surgical setting and one year of experience in discharge planning/utilization management preferred. Knowledge of InterQual criteria required. Familiarity with Medicare, Medicaid, managed care, and other 3rd party payor expectations and community resources is helpful.

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