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Mass General Brigham is seeking a Registered Nurse (RN) Home Health Case Manager, Acute Care Case Management for a nursing job in Somerville, Massachusetts. CCM or ACMA certification preferred Experience - Prior experience in the following areas: - general acute care hospital experience - healthcare reimbursemen t including utilization review - quality improvement - enhanced models of health care delivery - Previous acute care hospital care coordination/discharge planning required Working Conditions - H ybrid- Hospital-based environment, in an emergency department setting potentially 1-2 days a week Mass General Brigham Job ID #3296433.
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Comprised of Tufts Medical Center, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, Care at Home - an expansive home care network, and large integrated physician network.
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Eliot's One Care Health Home program is an innovative Care Management approach for members with complex medical, behavioral health, and social needs who are dual eligible, having both Masshealth and Medicare benefits.
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Provide overall clinical supervision and oversight of care coordination and service delivery of assigned Health Home Team(s). Responsibilities: Oversee the clinical operations of the Health Home Outreach Care Team. Provide supervision and clinical guidance on Annual MDS Comprehensive Assessment, Person-Centered Care Plan (PCCP) and the Member Engagement process.
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Mass General Brigham Healthcare at Home serves patients from rehabilitation after illness or injury, to chronic disease management. Skilled nursing care is provided in the form of assessment, teaching, treatment, documentation and care coordination demonstrating high quality customer service, and financial awareness.
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Patient care is delivered within organizational philosophy, policy and standards of community health practice. The admissions process and case management responsibilities are performed in accordance with MGB Healthcare at Home policies and standards of practice, utilizing thorough and timely electronic documentation and interdisciplinary communications.
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We’re helping patients get the best care possible by working on digital health experience, analyzing big data to streamline the delivery of care, and reaching out to medically complex patients to better understand their needs.
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Description Mass General Brigham Healthcare at Home serves patients from rehabilitation after illness or injury, to chronic disease management. Diversity Statement Mass General Brigham Healthcare at Home, an affiliate of Mass General Brigham, is committed to supporting patient care, research, teaching, and service to the community.
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Disorder, Substance Abuse Treatment Program, Home-Based Primary Care, Mental Health Intensive Case Management, Caregiver Support Program or Transition and Care Management Program, or a combination of programs located at one facility or.
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Prior home care experience preferred. The admissions process and case management responsibilities are performed in accordance with MGB Healthcare at Home's policies and standards of practice, utilizing thorough and timely electronic documentation and interdisciplinary communications.
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Conducts telephonic patient outreach for patients discharged from the inpatient setting, emergency department and skilled nursing facility to ensure transitions of care including follow-up appointments, prescriptions are filled, homecare services are set-up and to encourage early symptom management with PCP and Urgent Care with a goal of preventing a readmission.
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Work with local hospitals, local Home Care and/or VNA case management to ensure safe discharges with appropriate service coordination. The Wellness Coordinator works in partnership with housing staff to engage residents in wellness assessments and health education programs, connect residents to needed services, provide a wide variety of case management tasks, ensure that all interventions are documented and tracked and to develop and strengthen partnerships with community provider organizations as needed.
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