RN GERIATRIC CASE MANAGER

Guided by the needs of our patients and their families, Massachusetts General Hospital aims to deliver the very best health care in a safe, compassionate environment; to advance that care through innovative research and education; and, to improve the health and well-being of the diverse communities we serve.

The PRIMECARE Nurse Care Manager is a member of a department providing fee-for-service geriatric care management services to elders and those who care for them.

• Perform comprehensive and targeted geriatric care management and “informal” caregiver assessments in a variety of settings.
• Analyze assessment issues and findings, research good quality, cost effective strategies and solutions.
• Develop a comprehensive written geriatric care management “action plan” based upon the elder’s safety, well being, goals and with consideration of the caregiver’s needs and goals.
• Provide concrete methodologies and recommendations for successful implementation of the action plan.
• Provide “action plan” implementation services which may include:
• care coordination to support delivery of medical, psychosocial care and associated care plans, activities of daily living, legal, financial management, etc.
• education regarding the health care delivery and reimbursement systems, prescription drug cost management, health & wellness programs, long term care insurance, health care proxy, asset and legal management, government, community agencies, public & private organizations, hiring through private entities, etc.
• advocacy, to include writing appeals, to ensure the elder’s safety, physical, legal & financial well-being, to support their caregiving & quality of life goals, navigate the healthcare delivery system, obtain third party reimbursement for covered goods and services, etc.
• assessment and monitoring of care being delivered to the elder and provision of recommendations to the elder and/or their representative regarding the advisability of the need to modify care, the care plan, providers and/or vendors, as necessary and appropriate
• consultation and/or conferencing with the elder & their formal, informal caregivers, family, significant others, representatives to assess issues, consolidate information, coordinate planning and care delivery with and for the elder
• assistance with selection and transitioning the elder from one environment to another
• Communication with the elder, their representative and/or providers to effectively implement plans and provide updates regarding ongoing eldercare care management issues and services.
• Practice and documentation of care management services per PRIMECARE professional standards of practice.
• Effective management of professional service billing.
• Patient Population Served:
• The staff member must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on his/her assigned unit.
• Senior Adult (55 to 64 yrs)
• Geriatric (65 yrs and up)

• Strong assessment and problem solving skills.
• Strong interpersonal skills.
• Ability to work independently with minimal supervision.
• Goal oriented and accountable.
• Demonstrated organizational and time management skills, including ability to flex schedule to meet client & business need.
• Strong oral and written communication skills.
• Interest and ability in small business operation and development
• Registered Nurse with current MA license
• Minimum of 5 years work experience, 2 of which must be related
• Current Massachusetts Driver’s License and ability to travel to client location/s