RN Case Manager / per-diem
On-site · Abington, Massachusetts, United States
Job Summary
RN Case Manager provides clinically-based case management, discharge planning and care coordination to optimize quality and cost-effective healthcare. Leads reviews for medical necessity, works with physicians and payers, facilitates timely discharge, and coordinates resources across care continuum. Collaborates with multidisciplinary teams to ensure appropriate utilization and timely patient transitions, maintaining documentation and adherence to regulatory and payer requirements. Must be licensed RN with strong negotiation and communication skills; Bachelor’s degree strongly preferred; 3-5 years acute care experience preferred; CCM/ACM certification within 2 years of hire. Responsibilities include reviewing records for admission/continued stay, coordinating with physicians, arranging referrals, and ensuring safe discharge planning; uses InterQual criteria and payer guidelines; maintains knowledge of provider benefits and community resources; supports quality improvement and regulatory compliance.”,
Required Qualifications
- RN - Registered Nurse
- Bachelor's degree preferred
- ACM-Accredited Case Manager or CCM-Certified Case Manager (within two years of hire)
- 3-5 years acute care hospital experience preferred
- Critical Care or Emergency Department experience highly desirable
- Knowledge of InterQual criteria and utilization management
- RN license in good standing
- Experience with EHR systems (eDischarge, Epic, CCM) and care coordination
- Strong negotiation, communication, and interdisciplinary collaboration skills
- Ability to multitask in a high-stress environment
- Knowledge of payer requirements and post-acute care resources
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