RN Case Manager, Home Hospital

Site: Mass General Brigham Home Care, Inc. Mass General Brigham relies on a wide range of professionals to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Mass General Brigham's Home Hospital program is redefining how and where acute care is delivered. We provide hospital-level care to medically complex adult patients—in the comfort of their own homes—using advanced clinical models, interdisciplinary collaboration, and innovative technology.

We are seeking an experienced RN Case Manager to coordinate care, manage utilization, and support safe transitions across the continuum for patients admitted to Home Hospital. The RN Case Manager partners closely with the healthcare team, payers, patients, families, and community-based organizations to coordinate care and develop and implement individualized discharge plans. This role is ideal for an experienced RN who enjoys critical thinking, autonomy, and working at the forefront of healthcare transformation.

Patient Population

Home Hospital cares for adult patients with a range of acute conditions, including heart failure, COPD exacerbations, pneumonia, cellulitis, and specialty populations such as those experiencing postpartum hypertension or cirrhosis.

Schedule & Work Environment

This is a full-time (40 hours/week) role designed to support work–life balance, with a four-day, 10-hour schedule (7:30 AM – 6:00 PM, subject to change) and participation in a weekend rotation. The position is primarily remote, allowing you to work from home while staying closely connected to a highly collaborative interdisciplinary care team. This position offers a flexible, supportive work environment within an innovative care model. Occasional on-site time may be required for training or team meetings at Home Hospital office locations.

Job Summary

Essential Functions:

• Identify patients who would benefit from case management services by utilizing high-risk screening criteria.
• Perform comprehensive assessments that address the patient's medical condition, functional status, psychosocial needs, and discharge planning requirements, thereby enhancing patient care throughout the continuum.
• Employ a collaborative process of assessment, planning, implementation, care coordination, monitoring, advocacy, and evaluation to meet the individual's health care needs.
• Meet patients' needs efficiently and effectively by enhancing the patient experience, upholding institutional standards for high-quality care, optimizing resource utilization, and supporting appropriate reimbursement.
• Coordinate post-acute services, community resources, and follow-up care to facilitate safe and effective patient transitions.
• Collaborate with the interdisciplinary care team to assess medical necessity and determine appropriate levels of care.
• Conduct admission and concurrent utilization reviews using approved clinical criteria.
• Complete timely and accurate insurance reviews and secure required third-party payer authorizations as required.
• Identify and address any service delays or inappropriate utilization of healthcare resources.
• Support initiatives to reduce readmissions by enhancing care coordination, communication, and follow-up processes.
• Educate patients and families about care plans, insurance coverage, and available post-acute care options.
• Ensure compliance with federal and state regulations related to discharge planning, including adherence to CMS regulations and organizational policies.
• Document assessments, care plans, and ongoing case management activities in accordance with organizational policy and regulatory requirements.
• Participate in quality improvement projects, audits, and special assignments as needed.

Qualifications

Education & Licensure

• Graduate of an accredited school of nursing (BSN preferred).
• Current Registered Nurse licensure in the Commonwealth of Massachusetts.
• CCM or ACMA certification is preferred.

Experience

• At least three years of clinical nursing experience is strongly preferred.
• A minimum of two years of experience in case management, utilization review, or discharge planning is strongly preferred.

Additional Job Details

• Demonstrates strong clinical judgment and independent decision-making abilities.
• Effectively collaborates within a multidisciplinary care team.
• Uses logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
• Establishes strong rapport and relationships with patients, caregivers, and team members.
• Manages time effectively, especially when working remotely from the care team.
• Proficient in Microsoft Office, Teams, 4Next, Interqual, and other industry-related software programs.

Remote Type: Hybrid

Work Location: 75-95 Wells Ave

Scheduled Weekly Hours: Employee Type Regular

Work Shift: Day (United States of America)

Pay Range: $72, $144,747.20/Annual

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth.

We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement: 1410 Mass General Brigham Home Care, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.

To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at Mass General Brigham.

Competency Framework: At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.