RN Case Manager / per-diem

RN Case Manager position focused on clinically based case management, discharge planning, and care coordination to optimize quality and cost-effective outcomes. Responsible for reviewing records to determine medical necessity, identifying opportunities to improve utilization across the continuum, and collaborating with multidisciplinary teams to implement timely discharge plans and resource referrals. Must coordinate, negotiate, and procure services for complex patients while maintaining high quality of care, using InterQual criteria, physician certification, and payer guidelines, with emphasis on reducing unnecessary hospitalization and ensuring appropriate care transitions. Roles include communicating with payers and care teams, supporting timely documentation, and ensuring adherence to regulatory requirements with a strong emphasis on patient advocacy, interdisciplinary collaboration, and quality improvement. Minimum qualifications include RN license and ACM/CCM credentials within two years, with 3-5 years of acute care experience preferred; Bachelor’s degree strongly preferred. Location noted as Abington, MA, United States.