RN Case Manager / per-diem
On-site · Quincy, Massachusetts, United States
Job Summary
RN Case Manager to coordinate discharge planning, utilization management, and care coordination for SSH&EC clients. Acts as a patient advocate and Case Manager to coordinate, negotiate, procure services and resources for, and manage the care of complex patients to facilitate quality and cost-efficient outcomes. Responsibilities include reviewing patient records for medical necessity using InterQual criteria, advising physicians, arranging prompt discharge planning, communicating with payers and physicians, and ensuring timely documentation and reimbursement. Collaborates with interdisciplinary teams, participates in quality improvement activities, maintains knowledge of payer requirements and resources, and supports utilization management across the continuum of care. Requires strong negotiation, communication, and critical thinking skills, knowledge of EHR systems (e.g., InterQual, Epic, MCCM), and active RN licensure. Minimum 32-hour commitment with night/weekend shifts and a major holiday.
Required Qualifications
- RN - Registered Nurse
- Minimum Education: Registered Nurse (RN) licensure
- Minimum Work Experience: 3-5 years acute care hospital experience preferred
- Required Licenses / Registrations: RN - Registered Nurse
- Required Certifications: ACM-Accredited Case Manager or CCM-Certified Case Manager within two years of hire
- Demonstrated skills in negotiation, communication, conflict management, interdisciplinary collaboration, management, creative problem solving, critical thinking, time management, and multitasking in high-stress environments
- Knowledge of healthcare financing, community and organizational resources, patient care processes, and data analysis
- Knowledge of utilization management as it relates to third party payers
- Knowledge of post-acute care community resources
- Experience with Managed Care preferred
- Excellent verbal and written communication skills
- Flexibility to adapt to changing priorities and regulations
- Basic computer skills
This role has closed. Sorce can match you with similar open roles and apply on your behalf.
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.