Case Manager

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Berkshire Health Systems
742 North Street
PITTSFIELD, MA 01201

Phone:(413) 447-2784
Fax:413-447-2091
Website: berkshirehealthsystems.org

Company Description:
Berkshire Health Systems offers individuals the opportunity to work in an environment where they will be challenged, supported, and respected. As the region’s leading provider of comprehensive healthcare services, our employees are affiliated with an award winning teaching hospital, dedicated colleagues, and world class technology. The BHS family is proud to deliver the kind of advanced healthcare most commonly found in large metropolitan centers.

Additional Business Name: Berkshire Medical Center

Case Manager
To Commensurate With Experience
Pittsfield
Full Time
CNA/RN/Medical
Bachelor's Degree
Required
3+
Required
RN Licensed - Currently licensed as an RN in MA

The Case Manager is responsible for managing the healthcare needs, facilitation and achievement of quality and cost outcomes of all patients within Berkshire Medical Center, across the continuum. The case manager, utilizing a multidisciplinary team approach, negotiates, procures, coordinates and monitors services and resources needed by patients. The case manager is responsible for reviewing the patient at admission, and in some instances prior to admission, and concurrently throughout the hospital stay for the appropriate level of care and utilization of resources. The case manager will perform transition care planning activities to secure appropriate post hospital care arrangements and will monitor the patient during the course of their hospitalization. The case manager participates with the performance improvement initiatives undertaken by Berkshire Health Systems

    • Three years clinical experience in acute care in areas such as internal medicine, surgery,
      orthopedics, mother/child, cardiology and oncology.
    • Three years clinical experience in Rehab Setting, Home Health and Long Term Care would be considered.
    • Ability to perform a comprehensive admission and discharge risk assessment related to
      quality, financial, payer benefit allowances and limitations, risk management and patient satisfaction.
    • Case Management experience required for weekend, temporary and per diem positions.
    • Experience specializing in utilization management (levels of care knowledge and
      demonstrable competence with evidence based criteria tools ), discharge planning to
      entities throughout a continuum of care, previous care management or third party insurance review required
    • Current knowledge of CMS (levels of care determinations), appeal rights & DPH regulations required
    • Current knowledge of Ma Pro QIO (appeals) required
    • Knowledge of regulatory and accreditation organizations such as Joint Commission, DPH and HealthGrades preferred
    • Organizational skills. Proven ability to analyze and present data. Computer literacy. Ability to plan, implements, and evaluate change.
    • Data management skills preferred
    • Proven excellent interpersonal and communication skills
    • Ability to maintain confidentiality
    • Proven collaboration & negotiation skills with providers, patients, families, insurance organizations and government agencies
    • Proven ability to work independently
    • Proven excellent organizational skills
    • Demonstrated ability to establish and maintain relationships with physicians
    • Knowledge of local community resources required
    • Knowledge of Medicare, Medicaid, third party commercial payers and reimbursement required
    • Computer experience required with proven ability to manage multiple open applications
    • Skills in data comprehension, research, analysis, interpretation, and judgement necessary to prepare a comprehensive summary report for files, management, legal and/or regulatory agencies upon request
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