RN Case Manager / per-diem
On-site · Hanover, Massachusetts, United States
Job Summary
RN Case Manager coordinates, negotiates, and manages care for complex patients under Case Management, applying criteria to determine medical necessity for admission and continued stay, performing discharge planning and care coordination to optimize outcomes and cost-efficiency. Requires collaboration with interdisciplinary team, utilization management for third-party payers, and timely communication to physicians and payers. Responsibilities include monitoring observation status transitions, arranging prompt discharges, and maintaining knowledge of payers and community resources; proficiency with InterQual, EHR systems (Epic, MCCM), and post-acute care referrals; maintaining licensure and case management certification. Minimum commitment includes night/weekend coverage and a major holiday per 4-week schedule, and ongoing review of patient status and care transitions across the continuum.
Required Qualifications
- RN - Registered Nurse
- ACM-Accredited Case Manager or CCM-Certified Case Manager within two years of hire
- Minimum Work Experience: 3-5 years acute care hospital experience preferred
- Critical Care or Emergency Department experience highly desirable
- Knowledge of InterQual criteria
- Ability to negotiate, communicate effectively, interdisciplinary collaboration
- Knowledge of healthcare financing, utilization management, post-acute care resources
- Maintains nursing licensure CEU credits and CCM/ACM certifications
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