RN Case Manager / per-diem
On-site · Cohasset, Massachusetts, United States
Job Summary
RN Case Manager position focusing on patient advocacy, care coordination, and discharge planning within an acute care setting. Responsibilities include reviewing medical records for observation and inpatient admissions to ensure appropriate utilization, determining medical necessity using InterQual criteria and payer guidelines, coordinating and communicating with physicians and multidisciplinary teams, arranging safe and timely discharges, and ensuring appropriate resource use to support cost-effective, high-quality care. The role requires collaboration with internal and external staff, ongoing quality improvement participation, and adherence to regulatory and payer requirements. Works minimum 32 hours with two night/weekend shifts every 4 weeks and one major holiday.
Required Qualifications
- RN - Registered Nurse
- ACM-Accredited Case Manager or CCM-Certified Case Manager within two years of hire
- Minimum Education not specified in posting beyond RN and bachelor's-prepared strongly preferred
- Minimum Work Experience: 3-5 years acute care hospital experience preferred
- Critical Care or Emergency Department experience highly desirable
- Knowledge of InterQual and utilization management for payers
- Demonstrated negotiation, communication, and critical thinking skills
- RN licensure in good standing
- Proficiency with EHR/Epic/InterQual/ MCCM
- Ability to multitask in high-stress environment
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