Transitions Care Manager

Watertown, MA 02472

Posted: 05/03/2019 Employment Type: Contract Industry: Nurse Job Number: 3821830

Are you interested in Health Care? Our client is looking for a Transitions Care Manager to join their team!

  • Receives and reviews reports to identify and prioritize members in need of care management
  • Collaborates with the health care team to develop the plan of care and patient flow
  • Intervenes to maintain care progression
  • Creates overall transitional and discharge plan of care
  • Utilizes motivational interviewing and teach back techniques
  • Works with Coordinators to delegate tasks, and manage escalations
  • Refers post-discharge medical questions/issues
  • Contacts and directly engages patient s primary care physician
  • Implements time-bound treatment
  • Collaborates with the care team to complete the medication reconciliation and management
  • Participates in member rounds, case reviews and care team huddles
  • Documents appropriately and timely in the care management information system
  • Collects data and provides written reports as requested
  • Performs other duties as assigned

  • Registered nurse with unrestricted Massachusetts license
  • Bachelor s in nursing preferred
  • Minimum of five years of clinical nursing experience
  • Experience in behavioral health case management
  • Experience in extended care planning (discharge planning to Rehab, SNF, home care, hospice)
  • Excellent interpersonal skills to form positive and collaborative relationships
  • Strong communication, time-management and problem-solving skills
  • Ability delegate and manages multiple tasks
  • Ability to work independently

Delsin Grubbs
Senior Recruiter

Delsin began working with The Panther Group in 2007. He left for a few years, then returned as a recruiter in 2013 after coaching high school football and winning a state championship with that team. He is father to a 14-year-old sophomore in high school.

Delsin loves all food, but eats sushi 2-3 times a week.

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